Eye Injections Reference Sheet for Ophthalmologists
| Date: | June 28, 2023 |
| To: | Health Plan of San Joaquin (HPSJ) Practitioners and Facilities |
| From: | HPSJ |
| Type: | Educational/Informational |
| Subject: | Eye Injections Reference Sheet for Ophthalmologists |
| Business: | Medi-Cal Managed Care |
The Pharmacy and Therapeutics (P&T) Committee provided medical benefit updates in a provider alert issued in April of 2023. As a result, the attached informational reference sheets have been provided for you to post in your office or anywhere convenient as these are common agents used by Ophthalmologists in relation to intravitreal injections.
These agents were previously listed as prior authorization (PA) required with no specific criteria. As of our March 2023 P&T meeting, HPSJ has tiered and put specific criteria for each of the agents. Therefore, the attached table makes it easier for providers to know what criteria applies for each agent.
If you have any questions, please call our Provider Services Team at 209-942- 6340, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared.
