Commercial and Medicare Supplemental claims data was queried and identified patients with 13,999 patients with knee osteoarthritis who had utilized bio-fermentation derived high molecular weight hyaluronic acid (Bio-HA) as a part of multimodal therapy (any combination of corticosteroid injection, opioids and non-opioid pain medications). The primary outcome of interest was multimodal therapy utilization before and after Bio-HA injections. The number of opioid prescriptions filled decreased significantly after Bio-HA injections. Of patients who continued to fill opioid prescriptions, the number of prescriptions per month decreased significantly. Similarly, the number of 'opioid days' supplied decreased after Bio-HA injections and the number of prescription pain medication-free days increased. Patients underwent intra-articular corticosteroid injections following Bio-HA injections.