Payer PolicyActive
Ocrelizumab (Ocrevus)
EVICORE-MEDICAL_DRUG-6F69D67B
EviCore by Evernorth
Effective: January 1, 2019
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Ocrevus (ocrelizumab) is covered only for adults (≥18) with FDA‑approved relapsing forms of MS or primary progressive MS; off‑label compendial uses are not approved. Coverage requires documentation of age and diagnosis, no active infection including hepatitis B, no concurrent disease‑modifying MS agents, no live vaccines during therapy, and evidence of clinical benefit for 12‑month initial and renewal approvals.
Coverage Criteria Preview
Key requirements from the full policy
"Ocrevus is indicated for the treatment of adult patients with relapsing forms of multiple sclerosis (MS)."
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