Traditional MedicarePrior AuthMedium impact
Ocrevus® (ocrelizumab) & Ocrevus Zunovo™ (ocrelizumab and hyaluronidase-ocsq) (Revised)
Humana·FL, KY, SC · Neurology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana has revised their prior authorization policy for Ocrevus (IV) and new Ocrevus Zunovo (subcutaneous) for multiple sclerosis treatment. The policy removes the requirement for trying two other therapies first for Medicaid patients with relapsing forms of MS, while maintaining this requirement for other plan types.
Action Required
By January 1, 2026: Update prior authorization workflows for Ocrevus and Ocrevus Zunovo. For Medicaid patients in FL, KY, and SC with relapsing MS, no prior therapy trials required. For Medicare patients with relapsing MS, document trial/contraindication of at least two specified therapies (dimethyl fumarate, fingolimod, glatiramer, Kesimpta, teriflunomide, or rituximab). All PPMS patients require definitive diagnosis documentation regardless of plan type.