Jetrea® (ocriplasmin)
No prior authorization required for:
- Emergency room
- Inpatient
- Skilled nursing facility
For further information, please see the Injectable Drugs page
Code(s): J7316
Benefit: Medical
Notes:
- Treatment of vitreomacular adhesion
- No prior authorization required
- Covered only for diagnoses H43.821-H43.829, vitreomacular adhesion