Forms and Documents

OCREVUS Access Solutions Enrollment Forms

The OCREVUS Start Form is required for enrollment in OCREVUS Access Solutions.

To download multiple files at once, select the checkbox next to each file you would like to download from the list above then click Download Selected. Documents will be downloaded as a .zip file.

Other Important Documents

Sample Letter of Medical Necessity – Patient Converting to OCREVUS

Use this sample letter as a guide when you draft a letter of medical necessity and submit a request for prior authorization to the patient's health insurance plan. This version is specifically written for patients switching to OCREVUS from a different therapy. Use the links below to find additional information to enclose in your letter.

FDA approval letter (Follow this link and search by the drug name)

Prescribing Information

Sample coding for OCREVUS

Sample Letter of Medical Necessity – Patient New to OCREVUS

Use this sample letter as a guide when you draft a letter of medical necessity and submit a request for prior authorization to the patient's health insurance plan. This version is specifically written for patients starting treatment with OCREVUS. Use the links below to find additional information to enclose in your letter.

FDA approval letter (Follow this link and search by the drug name)

Prescribing Information 

Sample coding for OCREVUS

Sample Letter of Medical Necessity – Patient to Remain on OCREVUS

Use this sample letter as a guide when you draft a letter of medical necessity and submit a request for prior authorization or reauthorization to the patient's health insurance plan. This version is specifically written for patients remaining on OCREVUS. Use the links below to find additional information to enclose in your letter.

FDA approval letter (Follow this link and search by the drug name)

Prescribing Information

Sample coding for OCREVUS

Sample Appeal Letter – Patient Converting to OCREVUS

Use this sample letter as a guide as you draft an appeal letter in the event the patient's health insurance plan denies coverage for OCREVUS. This version is specifically written for patients switching to OCREVUS from a different therapy. Use the links below to find additional information to enclose in your letter.

FDA approval letter (Follow this link and search by the drug name)

Prescribing Information

Sample coding for OCREVUS

Sample Appeal Letter – Patient New to OCREVUS

Use this sample letter as a guide as you draft an appeal letter in the event the patient's health insurance plan denies coverage for OCREVUS. This version is specifically written for patients new to OCREVUS. Use the links below to find additional information to enclose in your letter.

FDA approval letter (Follow this link and search by the drug name)

Prescribing Information

Sample coding for OCREVUS

Sample Appeal Letter – Patient to Remain on OCREVUS

Use this sample letter as a guide as you draft an appeal letter in the event the patient's health insurance plan denies coverage for OCREVUS. This version is specifically written for patients remaining on OCREVUS. Use the links below to find additional information to enclose in your letter.

FDA approval letter (Follow this link and search by the drug name)

Prescribing Information

Sample coding for OCREVUS

 

Enrolling in the Genentech Patient Foundation

The Genentech Patient Foundation gives free medicine to people who don't have insurance coverage or who have financial concerns and to people who meet certain income criteria.

Fax Cover Letter

Use this cover sheet when faxing documents to OCREVUS Access Solutions.