Payer PolicyActive
Ocrelizumab (Ocrevus)
EVICORE-MEDICAL_DRUG-8171BCB5
EviCore by Evernorth
Effective: March 1, 2022
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Ocrevus (ocrelizumab) is covered for adults (≥18) with FDA‑approved relapsing forms of MS (including clinically isolated syndrome, relapsing‑remitting, active secondary progressive) or primary progressive MS, and non‑FDA indications are excluded. Approval is for 12 months and requires prescription by or consultation with an MS specialist/neurologist, documentation of diagnosis and age, planned dosing per label (initial 2×300 mg 2 weeks apart or 600 mg IV every 6 months), and meeting applicable safety criteria.
Coverage Criteria Preview
Key requirements from the full policy
"Ocrevus is indicated for the treatment of adult patients with relapsing or primary progressive forms of multiple sclerosis (MS)."
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