Back to drug list

Ocrevus (ocrelizumab)


Billing

Code: J2350

Description: Injection, ocrelizumab, 1 mg

Unit: 1 mg

Payment: $61.417

Pay quarter: Q3 2023


Medicare history

Dosage and Frequency

Multiple Sclerosis (MS)

Induction:
• 300mg IV at weeks 0 and 2

Maintenance:
• 600mg IV every 6 months

Calculate drug reimbursement


Total Reimbursement:

$39,061.21

(ASP: $36,850.20, Margin: $2,211.01)


Code:

J2350

# Units to bill:

600

Prior Authorization

Prior auth criteria for Ocrevus may include but is not limited to:


1. Diagnosis of relapsing or primary progressive multiple sclerosis.
2. Age 18 years or older.
3. Demonstration of failure or intolerance of two or more disease-modifying treatments for MS.
4. Evidence of an adequate serum ferritin level.
5. Negative serology for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV).
6. Screening for progressive multifocal leukoencephalopathy (PML) risk factors.
7. Documentation of a documented history of at least one documented clinical relapse in the previous 12 months, or two documented clinical relapses in the previous 24 months.
8. A complete blood count (CBC) and hepatic function tests (LFTs) are required prior to the initiation of treatment.
9. A negative pregnancy test is required prior to the initiation of treatment.
10. Documentation of an adequate level of adherence to any other chronic medications.


Insurance prior auth guidelines:

United Healthcare

Anthem

Cigna

Aetna


Billable NDCs

50242-0150-01

OCREVUS (GENENTECH, INC.)

300 MG



Resources

Drug Enrollment Form

Website