CommercialPrior AuthHigh impact
08.01.38f, Ocrelizumab (Ocrevus®) and Ocrelizumab and Hyaluronidase-ocsq (Ocrevus Zunovo®)
Independence Blue Cross·Neurology, Pharmacy·Pharmacy
Effective date
Sep 7, 2026
We identified it
Sep 9, 2026
Summary
Policy 08.01.38f updates medical necessity criteria for Ocrelizumab (Ocrevus®) and Ocrelizumab and Hyaluronidase-ocsq (Ocrevus Zunovo®). The policy became effective on 09/07/2026 and was posted on 09/08/2026. Specific details of the criteria changes are not provided in the source material, requiring immediate review of the full policy document.
Action Required
By 09/07/2026: Billing and clinical teams must obtain and review the complete policy text at https://medpolicy.ibx.com/ibc/Commercial/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=09&FilterField2=MPSiteActivityLogYear&FilterValue2=2026#commercial-08-01-38f to identify specific medical necessity criteria changes. Update billing system requirements, prior authorization workflows, and clinical documentation templates to reflect the new criteria. Communicate changes to providers prescribing Ocrevus or Ocrevus Zunovo. Failure to implement updated medical necessity criteria will result in claim denials for non-compliant submissions.