Eye Injections Reference Sheet for Ophthalmologists
| Date: | May 1, 2024 |
| From: | Health Plan |
| To: | Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) Ophthalmologists |
| Type: | Informational/Educational |
| Subject: | Eye Injections Reference Sheet for Ophthalmologists |
| Business: | Medi-Cal Managed Care |
The Pharmacy and Therapeutics (P&T) Committee previously provided medical benefit updates in the Provider Alert issued in April of 2024.
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. The attached table makes it easier for providers to know which criteria is applied for each agent.
Please note that it is highly recommended and preferred for Prior Authorization requests submitted for intravitreal medications to be submitted for durations up to 1 year at a time instead of per one date of service.
If you have any further questions, please contact your Provider Services Representative, 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. The most recent information about Health Plan and our services is always available on our website WWW.HPSJ-MVHP.ORG
