CommercialPrior AuthMedium impact
08.01.38d, Ocrelizumab (Ocrevus®) and Ocrelizumab and Hyaluronidase-ocsq (Ocrevus Zunovo™)
Independence Blue Cross·Neurology, Oncology·Pharmacy
Effective date
Apr 21, 2025
We identified it
Jun 19, 2026
Summary
The medical necessity criteria for Ocrelizumab (Ocrevus®) and Ocrelizumab and Hyaluronidase-ocsq (Ocrevus Zunovo™) have been updated for commercial plans. This change affects prior authorization requirements and coverage determinations for these multiple sclerosis medications.
Action Required
By April 21, 2025: Billing team must review updated medical necessity criteria for Ocrelizumab (Ocrevus®) and Ocrelizumab and Hyaluronidase-ocsq (Ocrevus Zunovo™) prescriptions. Update prior authorization workflows to ensure documentation meets new criteria requirements. Train staff on revised coverage guidelines to prevent claim denials.