ModifiedMass General Brigham Health PlanPolicy N/A

Ocrevus (ocrelizumab)

Defines prior authorization requirements, coverage criteria, continuation criteria, specialty pharmacy requirement, benefit (pharmacy), quantity limits, and program contact information for Ocrevus and Ocrevus Zunovo for Mass General Brigham Health Plan commercial/exchange members. Applies to pharmacy benefit only as of 01/01/2026.

Policy Summary

PayerMass General Brigham Health Plan

PolicyOcrevus (ocrelizumab)

Policy CodePolicy N/A

Change TypeCoverage and scope modifications (material)

Effective DateJan 1, 2026

Next Review Date

Key ActionPrior authorization is required under the pharmacy benefit and the medication must be filled at a contracted specialty pharmacy; submit documentation for new-to-plan members showing current receipt of the requested medication (excluding samples and manufacturer assistance).

SourceLink

POLICY UPDATE CHANGES

Policy updated to indicate it no longer applies to the medical benefit.

Ocrevus Zunovo (ocrelizumab and hyaluronidase-ocsq) added to policy and covered at parity with Ocrevus.

Streamlined diagnosis language and removed requirement that member is not using the requested medication concomitantly with other disease modifying MS agents.

12 monthsStandard Approval Duration

2 vials/24wOcrevus pharmacy quantity limit

1 vial/24wOcrevus Zunovo pharmacy quantity limit

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Coverage Summary

Ocrevus (ocrelizumab) and Ocrevus Zunovo (ocrelizumab and hyaluronidase-ocsq) are indicated for the treatment of relapsing forms of multiple sclerosis (including clinically isolated syndrome, relapsing‑remitting disease, and active secondary progressive disease) and primary progressive multiple sclerosis in adults.

This policy governs pharmacy benefit coverage and prior authorization for Mass General Brigham Health Plan commercial/exchange members, including specialty dispensing requirements and quantity limits. Prior authorization is required under the pharmacy benefit for these agents.

Effective 01/01/2026, the policy applies to the pharmacy benefit only (no longer applies to the medical benefit).

Key Policy Facts

Standard Approval Duration12 months

Ocrevus quantity limit2 vials per 24 weeks (pharmacy benefit)

Ocrevus Zunovo quantity limit1 vial per 24 weeks (pharmacy benefit)

Dispensing RequirementMust be filled at a contracted specialty pharmacy (designated specialty)

Effective date2026-01-01

Last review2025-10-08

Initial Therapy Criteria

Initial Authorization

Authorization may be granted when ALL of the following are met:

ALL of the following

Member is new to the plan within the past 90 days and currently receiving treatment with the requested medication
Excludes when the product is obtained as samples or via manufacturer's patient assistance programs
OR member meets diagnosis criteria
- Relapsing forms of multiple sclerosis (including clinically isolated syndrome, relapsing-remitting and secondary progressive disease)
- Primary progressive multiple sclerosis

Alternative Initial Authorization Path (Diagnosis-based)

Continuation Therapy Criteria (Reauthorization)

Continuation of Therapy / Reauthorization

Requests for reauthorization will be approved when ALL of the following are met:

ALL of the following

Member is experiencing disease stability or improvement

Approval Duration

ALL of the following

Approvals will be granted for 12 months

Provider Actions & Operational Requirements

Prior Authorization

Prior authorization required

Prior authorization is required under the pharmacy benefit (Program Type: Prior Authorization) and the medication is designated specialty; must be filled at a contracted specialty pharmacy.

Documentation Required

New-to-plan continuation documentation

For members new to the plan within the past 90 days who are currently receiving treatment, documentation must show current receipt of the requested medication; samples and manufacturer's patient assistance program supplies are excluded.

Applicable Codes

Benefit / Program Applicabilitymixed

No codes listed

Clinical Evidence & References

Prescribing information - Ocrevus (Genentech, June 2024).

Prescribing information - Ocrevus Zunovo (Genentech, September 2024).

Background

Ocrevus (ocrelizumab) and Ocrevus Zunovo (ocrelizumab and hyaluronidase-ocsq) are indicated for treatment of relapsing forms of multiple sclerosis (including clinically isolated syndrome, relapsing‑remitting, and secondary progressive disease) and primary progressive multiple sclerosis in adults.

The policy governs pharmacy benefit coverage for Mass General Brigham Health Plan commercial/exchange members and requires prior authorization under the pharmacy benefit; these products are designated specialty and must be filled at a contracted specialty pharmacy.

Authorization pathways include continuation for members new to the plan within the past 90 days who are currently receiving the medication (excluding samples and manufacturer patient assistance program supplies), or diagnosis‑based approval for the listed MS indications. Reauthorization requires evidence of disease stability or improvement, and approvals are granted for 12 months. Pharmacy quantity limits apply: Ocrevus vial: 2 vials per 24 weeks; Ocrevus Zunovo: 1 vial per 24 weeks.

Per review history, Ocrevus Zunovo was added and covered at parity with Ocrevus (effective 03/01/2025), and the policy was updated to apply to the pharmacy benefit only effective 01/01/2026.

Revision History

01/01/2026addedLatest

Policy updated to indicate it no longer applies to the medical benefit (Effective 01/01/2026).

03/01/2025added

Ocrevus Zunovo (ocrelizumab and hyaluronidase-ocsq) added to policy and covered at parity with Ocrevus (recorded 12/11/2024; effective 03/01/2025).

12/11/2024revised