Payer PolicyActive
Ocrevus (ocrelizumab)
EVICORE-MEDICAL_DRUG-010A223A
EviCore by Evernorth
Effective: May 1, 2024
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Covers Ocrevus (ocrelizumab) for adults ≥18 with FDA‑approved indications (relapsing forms of MS — CIS, RRMS, active SPMS — and primary progressive MS); off‑label uses are excluded. Authorization is for 12 months, must be prescribed by or in consultation with a neurologist/MS specialist, follow PI dosing (initial 300 mg IV x2 two weeks apart then 600 mg IV q6 months), and reauthorization requires ≥12 months on therapy plus objective evidence of benefit or stabilization (e.g., MRI, EDSS/NEDA criteria, relapse reduction, functional test improvements).
Coverage Criteria Preview
Key requirements from the full policy
"Ocrevus is indicated for the treatment of: Relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease..."
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