Medicare AdvantagePrior AuthHigh impact
MA08.088f, Ocrelizumab (Ocrevus®) and Ocrelizumab and Hyaluronidase-ocsq (Ocrevus Zunovo®)
Independence Blue Cross·Neurology, Internal Medicine, Rheumatology·Pharmacy
Effective date
Sep 7, 2026
We identified it
Sep 9, 2026
Summary
This is a 1-day-old policy update for Ocrelizumab (Ocrevus®) and Ocrelizumab with Hyaluronidase (Ocrevus Zunovo®) affecting Medicare Advantage plans. The policy modifies medical necessity criteria for these drugs, effective 09/07/2026. Without access to the full policy text details, the billing team must immediately obtain and review the complete criteria to determine impact on prior authorization requirements, documentation standards, and claims processing.
Action Required
By 09/14/2026: Billing team and clinical staff must obtain the complete MA08.088f policy text from the source URL and review all medical necessity criteria changes. Identify any new prior authorization requirements, documentation standards, or eligibility restrictions for Ocrevus® and Ocrevus Zunovo® claims. Update billing system rules, prior auth workflows, and provider encounter documentation templates accordingly. Communicate changes to all providers who prescribe these medications. Any claims submitted after 09/07/2026 without compliance to updated criteria will be subject to denial.