Description: Injection, ocrelizumab, 1 mg
Unit: 1 mg
Pay quarter: Q4 2023
Dosage and Frequency
• 300mg IV at weeks 0 and 2
• 600mg IV every 6 months
Calculate drug reimbursement
(ASP: $34,270.75, Margin: $2,056.25)
# Units to bill:600
Prior auth criteria for Ocrevus may include but is not limited to:
1. Diagnosis of relapsing or primary progressive multiple sclerosis.
2. Age 18 years or older.
3. Demonstration of failure or intolerance of two or more disease-modifying treatments for MS.
4. Evidence of an adequate serum ferritin level.
5. Negative serology for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV).
6. Screening for progressive multifocal leukoencephalopathy (PML) risk factors.
7. Documentation of a documented history of at least one documented clinical relapse in the previous 12 months, or two documented clinical relapses in the previous 24 months.
8. A complete blood count (CBC) and hepatic function tests (LFTs) are required prior to the initiation of treatment.
9. A negative pregnancy test is required prior to the initiation of treatment.
10. Documentation of an adequate level of adherence to any other chronic medications.
Insurance prior auth guidelines:
OCREVUS (GENENTECH, INC.)