Downloadable Forms

Electronic Funds Transfer (EFT) Authorization Form

This form is used to initiate the EFT registration process when the practice chooses not to use check reimbursements. It is a one-time registration completed by the practice.

Verification of Administration Form

This form is used when the drug is not clearly identified on the explanation of benefits (EOB). This form can accompany the EOB.

One-Time Check Request Form

This form is used to initiate a one-time check reimbursement.

Check Request Authorization Enrollment Form

This form is used to initiate the check reimbursement process. It is a one-time registration completed by the practice.

Indication and Important Safety Information

Indications

OCREVUS is indicated for the treatment of:

  • Relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults
  • Primary progressive MS, in adults.

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 (≥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.

The OCREVUS Prepaid MasterCard® is issued by Comerica Bank pursuant to license by MasterCard International. No cash or ATM access. The card can be used only to purchase prescriptions at participating merchant locations where Debit MasterCard is accepted.