CommercialDocumentationMedium impact
08.01.38d, Ocrelizumab (Ocrevus®) and Ocrelizumab and Hyaluronidase-ocsq (Ocrevus Zunovo™)
Independence Blue Cross·Pharmacy, Neurology, Rheumatology·Pharmacy
Effective date
Apr 21, 2025
We identified it
Jun 19, 2026
Summary
Policy 08.01.38d updates medical necessity criteria for Ocrelizumab (Ocrevus®) and Ocrelizumab and Hyaluronidase-ocsq (Ocrevus Zunovo™). This is a pharmacy policy change effective 04/21/2025 that impacts coverage requirements for these biologic medications. The billing team must review updated medical necessity documentation requirements to ensure claims meet current coverage guidelines.
Action Required
By 04/21/2025: Billing and clinical teams must obtain and review the complete Policy 08.01.38d text to identify specific medical necessity criteria changes for Ocrevus® and Ocrevus Zunovo™. Update prior authorization workflows and claim submission templates in the billing system to reflect new criteria. Communicate updated documentation requirements to providers submitting these medications. Ensure all claims submitted after 04/21/2025 include documentation satisfying the new medical necessity standards. Claims lacking required documentation will be denied.