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