Medical Policy Updates

Notification of Policy Revisions Effective October 13, 2020 (Posted August 11, 2020)

Medical Policy Revision
Ocrelizumab (Ocrevus®) "Notification" Updated SOC criteria in "Policy Guidelines" section from "first infusion OR less than 3 months since first infusion" to "the patient is new to therapy, defined as initial infusion OR less than 3 months since initial infusion" for clarity. Added the following to SOC criteria: "first infusion after at least a one-month gap in therapy outside of the approved dosing interval for drugs requiring every 6 months dosing duration (i.e. at least seven months of no ocrelizumab infusions)". Notification given 8/11/2020 for effective date 10/13/2020. 
Place of Service for Medical Infusions "Notification"  Updated criteria in "When Covered" section from "first infusion OR less than 3 months since first infusion" to "the patient is new to therapy, defined as initial infusion OR less than 3 months since initial infusion" for clarity. Added the following to "When Covered" section: "first infusion after at least a one-month gap in therapy outside of the approved dosing interval for drugs requiring every 6 months dosing duration," and added the following clarification to "first infusion after six months of no infusions": "for drugs with an approved dosing interval less than 6 months duration". Notification given 8/11/2020 for effective date 10/13/2020.