JETREA (ocriplasmin) Released for Treatment of Vitreomacular Adhesion

ThromboGenics will begin shipping JETREA® (ocriplasmin) via specialty distributors today. JETREA is the first, and so far the only, pharmacologic option for vitreomacular adhesion (VMA), also known as vitreomacular traction. The FDA notes that, “JETREA is an enzyme that breaks down proteins in the eye responsible for VMA. The breakdown of these proteins allows a better separation between the vitreous and macula and can reduce the chances that tugging will occur.” The medication was approved by the FDA on October 17, 2012; the press release can be accessed via this link.

Potential users of JETREA should be aware of the following:

• Few, if any payers have published coverage policies, so whenever possible you should contact the payer for prior authorization. Carefully document the patient’s condition and the medical and surgical treatment alternatives considered.

• Each vial of JETREA contains 0.5 mg ocriplasmin in 0.2 mL citric-buffered solution (2.5 mg/mL). JETREA is supplied in a 2 mL glass vial with a latex free rubber stopper. 

• If bilateral treatment is indicated, the manufacturer recommends waiting at least 7 days between treatments.

• Storage for JETREA is significantly different than most offices are used to. The FDA-approved package insert (link here) notes “Store frozen at or below -4°F (-20°C). Protect the vials from light by storing in the original package until time of use.”

• Since -4 degrees Fahrenheit is colder than many office medication refrigerators/freezers are capable of achieving, special considerations are in order. Offices may need to acquire another freezer and should also consider a means to monitor the freezer temperature to ensure JETREA will work as indicated when used. Check with the manufacturer at (855) TRY-JETREA (879-5387) [Option 4] for storage and freezer information.

• The NDC number for JETREA is 24856-0001-00.

• Wholesale acquisition cost is estimated to be $3,950.00 per dose. Vials are for single use only.
  

Coding for the drug remains uncertain. Until a HCPCS code is approved (possibly later in 2013), Corcoran Consulting Group recommends J3590, unclassified biologic. Some payers may require J3490, unclassified drugs. A box 19 comment on the CMS 1500 form with the drug dose and NDC is likely needed. CPT coding for the injection procedure at present is 67028, intravitreal injection. The ICD-9-CM code for the FDA-approved indication is 379.27, Vitreomacular adhesion.

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