Why Don’t Insurances Cover PRP Injections?

By Dr. Jeffrey Peng, MD · Published March 5, 2026 · 10 min read

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One of the most common questions patients ask at their first consultation is whether their health insurance will cover platelet-rich plasma (PRP) injections. It is an understandable concern — PRP is one of the most effective nonsurgical treatments available for conditions like knee osteoarthritis and chronic tendon injuries, yet the vast majority of insurance companies in the United States still refuse to cover it. This article explains why that gap exists, what the evidence actually shows, and what it will take for coverage to change.

Which Insurance Plans Currently Cover PRP?

As of this writing, the only health insurance plan in the United States that covers PRP injections is Tricare, the healthcare program for active-duty military service members and their families. This makes intuitive sense — the military has a direct financial incentive to return service members to full physical readiness as quickly and effectively as possible.

Every other major insurer — including Cigna, Blue Cross Blue Shield, Aetna, UnitedHealthcare, and Medicare — still classifies PRP as experimental or investigational and declines coverage. In my practice, this is one of the most frustrating barriers patients face when pursuing evidence-based nonsurgical care.

What Does the Research Say About PRP Effectiveness?

Despite what insurance companies claim, there is now substantial evidence supporting PRP as a safe and effective treatment for multiple musculoskeletal conditions. Consider knee osteoarthritis alone: multiple randomized controlled trials, systematic reviews, and meta-analyses have demonstrated that PRP injections produce better patient outcomes than corticosteroids, hyaluronic acid, and placebo for the treatment of mild to moderate symptomatic knee osteoarthritis. Newer studies have even suggested that PRP may slow the structural progression of arthritis and delay the need for joint replacement surgery.

The benefits extend beyond the knee. PRP has also been shown to be superior to other nonsurgical treatments for common conditions such as tennis elbow and golfer’s elbow. A systematic review published in Arthroscopy found that PRP injections offered similar levels of improvement in pain and function when compared to surgery for lateral epicondylitis (Hardy et al., 2021).

What Do Major Medical Societies Say About PRP?

It is not just individual clinical trials that support PRP — major medical organizations have weighed in as well.

European Alliance of Associations for Rheumatology (EULAR)

A task force presented at the 2020 EULAR E-Congress developed a consensus statement with several notable recommendations. The panel concluded that intra-articular PRP injections are an effective symptomatic treatment for early to moderate knee osteoarthritis, that PRP may also be useful in severe knee osteoarthritis, and that PRP treatment should be offered as a second-line option after failure of oral or nonpharmacological treatments (Eymard, EULAR 2020 Abstract AB0862). In practical terms, this means that if anti-inflammatory medications like ibuprofen or naproxen — or exercise and physical therapy — do not adequately control symptoms, EULAR supports proceeding with PRP injections.

American Academy of Orthopaedic Surgeons (AAOS)

The AAOS published a technology overview on PRP for knee osteoarthritis. The authors concluded that the literature supports the hypothesis that PRP can offer statistically significant benefit compared to placebo and active treatment alternatives such as hyaluronic acid, corticosteroids, and NSAIDs for patient-reported outcomes related to pain and symptoms at time points up to 12 months.

American Medical Society for Sports Medicine (AMSSM)

The AMSSM released a position statement on the responsible use of regenerative medicine and orthobiologics (Finnoff et al., 2021). The statement noted that research suggests PRP injections are more effective in reducing pain and improving function than steroid or hyaluronic acid injections for knee osteoarthritis, particularly in patients who are younger and have mild to moderate disease. For tendons, the statement highlighted that multiple randomized controlled trials have demonstrated positive results for lateral epicondylitis, gluteus medius tendinopathy, and plantar fasciopathy treated with PRP.

Why Do Insurance Companies Still Refuse to Cover PRP?

The Safety Argument

Some insurers cite an unknown safety profile as a justification for noncoverage. In my clinical experience, this is not a credible concern. PRP is derived entirely from the patient’s own blood — it is autologous — making it one of the safest injectable treatments available. Multiple randomized controlled trials and systematic reviews have confirmed a favorable long-term safety profile. Interestingly, the same cannot be said of cortisone injections, which are universally covered by insurance despite evidence that repeated steroid injections can weaken tendons and damage healthy cartilage, potentially accelerating arthritis progression.

The Conflicting Evidence Argument

A more nuanced objection is that some clinical trials have found PRP to be no better than placebo. Insurers point to trials such as the RESTORE trial (Bennell et al., 2021) and the PEAK trial (PMID 35638203) as evidence that PRP does not work for knee osteoarthritis. When insurance companies — or even some physicians — read the conclusions of these studies, they understandably conclude that PRP is ineffective.

However, this interpretation misses a critical nuance: not all PRP is the same, and dosing matters enormously.

Does PRP Dosing Affect Clinical Outcomes?

Just as with any pharmaceutical intervention, the dose of PRP matters. Consider a simple analogy: if a patient takes 20 mg of ibuprofen for a headache and it does not help, the correct conclusion is not that ibuprofen is ineffective — it is that the dose was insufficient. The therapeutic dose for a headache is typically 400 to 600 mg, meaning the patient underdosed the medication by a factor of 20.

The same principle applies to PRP. The RESTORE trial used a preparation kit that produced approximately 1 to 2 billion platelets. The PEAK trial used a kit that yielded approximately 2 to 3 billion platelets. Emerging clinical data now demonstrate a clear dose-response curve for PRP, and the threshold for clinical benefit in knee osteoarthritis appears to be approximately 10 billion platelets, which typically requires a blood draw of at least 60 cc.

What the RESTORE and PEAK trials actually demonstrated is that low-dose PRP is not effective for knee osteoarthritis — a finding that is entirely consistent with dose-response pharmacology. This is why newer studies are investigating the higher end of the dose-response curve, starting with blood draws of 60 cc and extending up to 120 cc.

PRP Dosing Guide: How Blood Draw Volume Affects Platelet Count

10 cc blood draw → ~1.5–2.4 billion platelets (low dose, similar to RESTORE trial)

20 cc blood draw → ~3.0–4.8 billion platelets (low dose, similar to PEAK trial)

30 cc blood draw → ~4.5–7.2 billion platelets (moderate dose, suitable for smaller joints)

60 cc blood draw → ~9.0–14.4 billion platelets (therapeutic dose for large joints — recommended target)

80 cc blood draw → ~12.0–19.2 billion platelets (high dose)

120 cc blood draw → ~18.0–32.0 billion platelets (maximum dose, used in newer research protocols)

Table adapted from Dr. Centeno. For large joints such as knees, hips, and shoulders, aim for a 60 cc blood draw yielding approximately 10 billion platelets. Smaller joints may respond to a 30 cc draw.

Will Cost-Benefit Data Finally Change Insurance Coverage?

In my opinion, the factor most likely to shift insurance coverage is not more efficacy data — it is economic data demonstrating that PRP saves money in the long run. To date, relatively few cost-benefit analyses have been published on this topic.

One notable exception is a cost-utility analysis published in BMC Musculoskeletal Disorders that examined the cost-effectiveness of PRP compared to other intra-articular injections for knee osteoarthritis in Iran (Raeissadat et al., 2023). The study found that PRP, compared to other injections, was the most cost-effective treatment option for patients with mild and moderate knee osteoarthritis and had the highest net monetary benefit among all injection therapies evaluated.

While this study was conducted in a single country, the underlying logic is broadly applicable. Patients who receive effective PRP treatment experience better symptom control and improved function, which enables them to remain physically active, maintain employment productivity, and exercise regularly. The downstream effects — reduced rates of obesity, diabetes, hypertension, and other comorbidities — translate into substantial long-term healthcare savings. For elderly patients with osteoarthritis, the ability to remain active also reduces fall risk, fracture-related hospitalizations, and the costs associated with long-term care.

Until rigorous cost-benefit analyses are conducted in the United States and other major healthcare markets, I believe it is unlikely that insurers will change their coverage policies. The decision, ultimately, comes down to money.

How Can Patients Ensure They Are Getting High Quality PRP?

If you are considering PRP and will be paying out of pocket, it is essential to ensure you are receiving a high-quality, appropriately dosed treatment. Ask your provider about the volume of blood drawn, the preparation system used, and the approximate platelet count of the final product. For large joints such as the knee, hip, or shoulder, a blood draw of at least 60 cc — yielding approximately 10 billion platelets — is the current target based on emerging evidence. Smaller joints such as the wrist, ankle, or foot may respond to a 30 cc draw. If you are interested in learning more about PRP therapy, I encourage you to learn more on my website or schedule a consultation to discuss whether PRP is appropriate for your condition.

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References

1. Hardy R, Tori A, Fuchs H, Larson T, Brand J, Monroe E. To Improve Pain and Function, Platelet-Rich Plasma Injections May Be an Alternative to Surgery for Treating Lateral Epicondylitis: A Systematic Review. Arthroscopy. 2021;37(11):3360-3367. doi:10.1016/j.arthro.2021.04.043

2. Bennell KL, Paterson KL, Metcalf BR, et al. Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial. JAMA. 2021;326(20):2021-2030. doi:10.1001/jama.2021.19415

3. The effectiveness of leucocyte-poor platelet-rich plasma injections on symptomatic early osteoarthritis of the knee: The PEAK randomized controlled trial. Bone Joint J. 2022;104-B(6):663-671. PMID: 35638203

4. Finnoff JT, Awan TM, Borg-Stein J, et al. American Medical Society for Sports Medicine Position Statement: Principles for the Responsible Use of Regenerative Medicine in Sports Medicine. Clin J Sport Med. 2021;31(6):530-541. doi:10.1097/JSM.0000000000000973

5. Raeissadat SA, Rahimi M, Rayegani SM, Moradi N. Cost-utility analysis and net monetary benefit of Platelet Rich Plasma (PRP) intra-articular injections compared to PRGF, Hyaluronic Acid, and ozone in knee osteoarthritis in Iran. BMC Musculoskelet Disord. 2023;24(1):22. doi:10.1186/s12891-022-06114-x

6. Eymard F. Consensus Statement on Intra-Articular Injections of Platelet-Rich Plasma for the Management of Knee Osteoarthritis. Abstract AB0862. Presented at: 2020 EULAR E-Congress.

7. American Academy of Orthopaedic Surgeons. Technology Overview: Platelet-Rich Plasma for Knee Osteoarthritis. AAOS.org

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Medical Disclaimer: This content is for educational purposes only and does not substitute for the medical advice of a physician. Always consult your healthcare provider before beginning any new treatment program. The information presented reflects the opinion of Dr. Jeffrey Peng and does not represent the views of his employers or affiliated hospital systems.