Medicare AdvantagePrior AuthMedium impact
MA08.088d, 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
Medicare Advantage has updated medical necessity criteria for Ocrelizumab (Ocrevus®) and Ocrelizumab with Hyaluronidase-ocsq (Ocrevus Zunovo™), which are specialty medications used primarily for multiple sclerosis treatment. This change affects prior authorization requirements and coverage criteria for these high-cost infusion therapies.
Action Required
By April 21, 2025: Billing team must review updated medical necessity criteria for Ocrelizumab (Ocrevus®) and Ocrelizumab with Hyaluronidase-ocsq (Ocrevus Zunovo™) prior authorizations. Update prior authorization workflows to ensure compliance with new Medicare Advantage requirements. Providers administering these medications must verify current authorization criteria before treatment to avoid claim denials.