Part B Drug Step Therapy | ProCare Advantage
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Part B Drug Step Therapy
Drug Classes Drug Name Status Billing Code
Ophthalmic Disorders Avastin Preferred C9257, J9035
Eylea Non-Preferred J0178
Lucentis Non-Preferred J2778
Macugen Non-Preferred J2503
Visudyne Non-Preferred J3396
Viscosupplements Monovisc Preferred J7327
Orthovisc Non-Preferred J7324
Durolane Non-Preferred J7318
Euflexxa Non-Preferred J7323
Gel-One Non-Preferred J7326
Gelsyn-3 Non-Preferred J7328
Genvisc 850 Non-Preferred J7320
Hylagan Non-Preferred J7321
Hymovis Non-Preferred J7322
Supartz Non-Preferred J7321
Supartz FX Non-Preferred J7321
Synvisc Non-Preferred J7325
Synvisc-One Non-Preferred J7325
TriVisc Non-Preferred J7329
Visco-3 Non-Preferred J7321

A trial and failure of the preferred drug must be documented before a non-preferred drug will be approved. All non-preferred drugs must be prior authorized. The preferred drugs do not require prior authorization.