Ocrevus

How to Use the Program

Your card may be used with one of the following types of health care providers: your doctor's office, infusion center, hospital or specialty pharmacy. Follow the steps below to use the program.

Tell your health care provider that you are using the OCREVUS Co-pay Program. Please show them your card. They will ask for the numbers on your card for processing.

After your treatment, your health insurance plan will send you an Explanation of Benefits statement, also called an "EOB."

The requirements for reimbursement must include:

Name of insurance company
Facility name
Patient's name
Date of Service (DOS)
Name of drug or J-code
Amount billed, Amount allowed, Patient responsibility, Amount paid to provider

If the EOB does not include any of the above items, additional documentation may be required to process the claim

The OCREVUS Co-pay Program needs to see your EOB to confirm your treatment. You or your doctor’s office can send it to us.*

Fax (855) MS-COPAY (855-672-6729)
Upload at OCREVUScopay.com
Mail to The OCREVUS Co-pay Program,

P.O. Box 2106, Morristown, NJ 07962

Your health care provider may use your card to pay for your costs.^† Depending on your health insurance plan’s policy, you may owe additional costs after using the card.

*EOBs must be submitted within 545 days from the date of service (DOS) for consideration.

^†This program helps with the costs of OCREVUS only. It does not help with the cost of other medicines you take at the same time as OCREVUS or with facility fees.

Indication and Important Safety Information

What is OCREVUS?

OCREVUS is a prescription medicine used to treat:

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.

It is not known if OCREVUS is safe or effective in children.

Who should not receive OCREVUS?

Do not receive OCREVUS if you have an active hepatitis B virus (HBV) infection.
Do not receive OCREVUS if you have had a life threatening allergic reaction to OCREVUS. Tell your healthcare provider if you have had an allergic reaction to OCREVUS or any of its ingredients in the past.

What is the most important information I should know about OCREVUS?

OCREVUS can cause serious side effects, including:

Infusion reactions: OCREVUS can cause infusion reactions that can be serious and require you to be hospitalized. You will be monitored during your infusion and for at least 1 hour after each infusion of OCREVUS for signs and symptoms of an infusion reaction.
Infection: OCREVUS increases your risk of getting upper respiratory tract infections, lower respiratory tract infections, skin infections, and herpes infections. If you have an active infection, your healthcare provider should delay your treatment with OCREVUS until your infection is gone.

What are the possible side effects of OCREVUS?

OCREVUS may cause serious side effects, including:

Risk of cancers (malignancies) including breast cancer. Follow your healthcare provider’s instructions about standard screening guidelines for breast cancer.

Most common side effects include infusion reactions and infections.

These are not all the possible side effects of OCREVUS.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

For more information, go to www.OCREVUS.com or call 1-844-627-3887.

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.