Ocrevus (ocrelizumab) Letter of Medical Necessity
Ocrevus (ocrelizumab) is the only approved therapy for primary progressive MS. PAs require diagnosis confirmation and pre-treatment screening documentation.
FDA-Approved Indications
- ● relapsing and primary progressive multiple sclerosis
Why Ocrevus Prior Authorization Gets Denied
The most common denial reasons across major payers:
- 1. MRI documentation missing
- 2. Hep B screening not documented
- 3. Prior DMT trial requirements
What to Include in a Ocrevus Letter of Medical Necessity
Document MS subtype, MRI findings, EDSS, prior therapies, hepatitis B screening, immunoglobulin levels, and infusion plan.
Key clinical evidence to cite:
- ✓ OPERA I, OPERA II, ORATORIO
Relevant guidelines:
- 📖 AAN MS Guidelines
Ocrevus Prior Authorization Criteria
Standard criteria across major US payers for Ocrevus. Specific criteria vary by plan — RxCheckUp tailors each LMN to your patient's exact payer policy.
Typical step therapy requirements:
- → Prior DMT trial requirements
Required documentation:
- ✓ ICD-10 diagnosis code with specificity
- ✓ Prior therapy history with dates, doses, and discontinuation reasons
- ✓ Specialist evaluation (where applicable)
- ✓ Baseline disease activity or biomarker results
- ✓ Clinical rationale citing FDA labeling or guidelines
Approval details:
Initial approval: typically 6 months. Renewal: 12 months with documented clinical response.
Payers Covering Ocrevus
RxCheckUp tailors each LMN to the specific payer's medical policy and step therapy requirements:
Ocrevus Prior Authorization FAQ
Why was my Ocrevus prior authorization denied?
The most common denial reasons for Ocrevus are: MRI documentation missing; Hep B screening not documented; Prior DMT trial requirements.
What should a Ocrevus Letter of Medical Necessity include?
Document MS subtype, MRI findings, EDSS, prior therapies, hepatitis B screening, immunoglobulin levels, and infusion plan.
Which payers cover Ocrevus?
Ocrevus is covered by major US payers including UnitedHealthcare, Aetna, Cigna, BCBS, Medicare Part B, though formulary tier and prior authorization criteria vary.