OCREVUS Coverage
Benefits Investigations
OCREVUS Access Solutions can conduct a benefits investigation
(BI) to help you determine if a Genentech medicine and the infusion
are covered, if prior authorizations (PAs) are required, which
specialty pharmacy (SP) the health insurance plan prefers and if
patient assistance might be needed.
Potential outcomes of a BI:
- Treatment is covered
- PA is required
- Treatment is denied
Once the BI is complete, your Patient Navigator will walk your patient through his or her insurance coverage for OCREVUS.
A BI may be initiated once the OCREVUS Start Form is submitted to OCREVUS Access Solutions.
This form can be downloaded from Forms and Documents or submitted online via My Patient Solutions.
The completion and submission of coverage- or reimbursement-related
documentation are the responsibility of the patient and health care
provider. Genentech makes no representation or guarantee concerning
coverage or reimbursement for any service or item.
Prior Authorization
Your OCREVUS Patient Navigator can help you identify if a prior
authorization (PA) is necessary and offer resources as you obtain it
for your patient. Once your practice has submitted a PA, your Patient
Navigator can follow up with the payer regarding the PA status.
Remember, submitting the PA is the responsibility of the practice. PA
support may be provided once the OCREVUS Start Form is submitted to
OCREVUS Access Solutions.
If your patient's request for a PA is not granted, your Education and Reimbursement Specialist (ERS) or Patient Navigator can work with you to determine your next steps. You can find more tips like this in Forms and Documents.
The completion and submission of coverage- or reimbursement-related documentation are the responsibility of the patient and health care provider. Genentech makes no representation or guarantee concerning coverage or reimbursement for any service or item.
Benefits Reverification
Your OCREVUS Patient Navigator can help you prepare for subsequent
OCREVUS treatments by automatically reverifying your patient’s
benefits prior to the next scheduled infusion.
PAN=Patient Authorization and Notice of Request for Transmission of Health Information to Genentech Access Solutions and Genentech® Access to Care Foundation.
SMN=Statement of Medical Necessity.
Important Safety Information & Indication
Indications
OCREVUS is indicated for the treatment of adult patients with relapsing or primary progressive forms of multiple sclerosis.
Contraindications
OCREVUS is contraindicated in patients with active hepatitis B virus infection and in patients with a history of life-threatening infusion reaction to OCREVUS.
Warnings and Precautions
Infusion Reactions:
Management recommendations for infusion reactions depend on the type and severity of the reaction. Permanently discontinue OCREVUS if a life-threatening or disabling infusion reaction occurs.
Infections:
Delay OCREVUS administration in patients with an active infection until the infection is resolved. Vaccination with live-attenuated or live vaccines is not recommended during treatment with OCREVUS and after discontinuation, until B-cell repletion.
Malignancies:
An increased risk of malignancy, including breast cancer, may exist with OCREVUS.
Most Common Adverse Reactions
RMS: The most common adverse reactions in RMS trials (incidence ≥10% and >REBIF): upper respiratory tract infections and infusion reactions.
PPMS: The most common adverse reactions (≥10% and >placebo): upper respiratory tract infections, infusion reactions, skin infections, and lower respiratory tract infections.
For additional safety information, please see the full Prescribing Information and Medication Guide.