Ocrevus Zunovo — Medical Mutual

Initial criteria

• Age ≥ 18 years
• Prescribed by, or in consultation with, a physician who specializes in the treatment of MS and/or a neurologist
• Used as single agent therapy (not in combination with any disease-modifying therapy for MS such as Avonex, Betaseron, Extavia, Rebif, Plegridy, Copaxone, Glatopa, Gilenya, Aubagio, Tecfidera, Tysabri, Lemtrada)
• Screened for hepatitis B virus prior to initiation and does not have active disease
• Site of care medical necessity criteria is met

Reauthorization criteria

• Beneficial response to therapy
• Site of care medical necessity is met

Approval duration

1 year