Multiple Sclerosis

Aetna covers ocrelizumab (Ocrevus) for relapsing MS (including RRMS and SPMS with relapses), clinically isolated syndrome, and primary progressive MS when criteria are met; alemtuzumab (Lemtrada) is covered for relapsing MS when criteria are met (first course after inadequate response to ≥2 MS drugs; subsequent courses ≥12 months after prior dose) but is not recommended for CIS. Briumvi and Lemtrada are restricted to members who have contraindication/intolerance or ineffective response to adequate trials of Ocrevus and natalizumab (Tysabri); Lemtrada and Ocrevus must be prescribed by or in consultation with a neurologist and none of Ocrevus, Lemtrada or Briumvi may be used concomitantly with other disease‑modifying MS agents.

"Intravenous Steroid Treatment: "Aetna considers intravenous steroid therapy medically necessary for either of the following indications: Treatment of acute exacerbations of multiple sclerosis (MS) ..."