OCREVUS (ocrelizumab)
OFFICE ADMINISTRATION - IV infusion
Indications for Prior Authorization:
- Treatment of adults with relapsing or primary progressive forms of multiple sclerosis (MS)
Patients must meet the following criteria for the indication(s) above:
- Relapsing, remitting MS (RRMS), secondary-progressive MS (SPMS), or primary progressive MS (PPMS) confirmed by a neurologist; AND
- Prescribed by or in consultation with a neurologist; AND
- Will not be authorized for anyone with active HBV infection; AND
- This drug may not be used in combination with any other disease-modifying therapy for MS either oral or injectable (e.g., Aubagio®, Avonex®, Betaseron®, Copaxone®, Extavia®, Gilenya®, Glatopa®, Rebif®, Tecfidera®, Tysabri®, or mitoxantrone)
- For RRMS/SPMS approved for monotherapy if:
- Patients with RRMS/SPMS who are poor responders (tried/failed an adequate trial as confirmed by chart note documentation) to at least one preferred first-line treatment (oral or injectable), and who develop accumulating disability despite therapy, OR
- Patient is not a candidate for any of the preferred first-line treatments due to the severity of their MS or if they are at higher risk of poor long-term outcome (those with spinal cord involvement, highly active disease, poor relapse recovery, etc.) as determined by their neurologist
Dosing:
- Initial dose is 300mg IV infusion, followed 2 weeks later by a second 300mg IV infusion. Maintenance is 600mg IV infusion once every 6 months.
- Premedication with methylprednisolone or an antihistamine is recommended
- Consider the use of an antipyretic
Coverage Duration:
-
1 year
Review History:
- 4/20/2021-Update to PA criteria for RRMS/SPMS
- 6/12/2017- Original review
References:
- Ocrevus Prescribing Information. Genentech, Inc. South San Francisco, CA. March 2021.
- Initial disease-modifying therapy for relapsing-remitting multiple sclerosis in adults. UpToDate. Mar 2021.
Last review date: April 20, 2021