Does Medicare Cover Ocrevus? 

In the United States today, there are approximately one million people living with the chronic neurological condition known as multiple sclerosis (MS). MS is a disease of the brain and central nervous system. It triggers the immune system into attacking the myelin, which is the material covering nerve cell axons. Myelin functions as the protective insulation around the axons as well as regulating the rate of the electrical impulses that flow along them. 

Without myelin, MS eventually causes deterioration of the nerve fibers and many people experience symptoms that can include the following:

  • Muscle spasms and stiffness
  • Paralysis or mobility issues
  • Bladder disfunction
  • Forgetfulness
  • Mood swings
  • Depression
  • Slurred speech
  • Dizziness and vertigo
  • Tremors and shakiness
  • Fatigue

As of now, there’s no cure for MS, but there are treatments that help manage symptoms and lessen the frequency and duration of attacks:

  • Certain prescription medications that include corticosteroids and interferon beta blockers 
  • Plasmapheresis 
  • Physical therapy 
  • Occupational therapy
  • Speech therapy 
  • Immunotherapy 
  • Lifestyle changes that include a diet high in nutrients, quality rest and sleep, and physical activity

One FDA-approved medication used to treat MS is ocrelizumab, which is a humanized anti-CD20 monoclonal antibody sold under the brand name Ocrevus. Your physician might prescribe this treatment for you if it’s a suitable option. Because it’s an expensive treatment, you should have information about how your Medicare insurance can help you cover the costs. 

Does Medicare cover Ocrevus infusions? 

Ocrevus must be administered through an intravenous infusion by a trained health care professional at an outpatient medical facility. Because you can’t administer this drug yourself at home, it is covered by Original Medicare Part B (medical insurance). To be eligible for this benefit, your physician, who accepts Medicare assignment, must certify that the drug is medically necessary to treat your condition. You must also have it done in a facility that accepts Medicare assignment. 

Original Medicare Part B pays 80 percent of the final approved cost for the drug Ocrevus, and for its administration. You pay the remaining 20 percent after meeting your annual Part B deductible. 

If you have a Medicare Advantage (Part C) plan, your provider is obligated to cover the same benefits as Original Medicare Parts A and B do, if you qualify for this coverage. Depending on the type of Medicare Advantage plan you have, you might be required to use plan-approved physicians and medical clinics to get coverage. Also, your costs out-of-pocket for Ocrevus treatments may differ from those charged by Original Medicare, so check with your plan provider before beginning treatments. 

How much do Ocrevus infusions cost without Medicare coverage? 

For someone who doesn’t have Medicare insurance coverage for Ocrevus, it can be a very expensive treatment. While there are several factors to take into account when determining the price of Ocrevus, the national average cost for treatment of multiple sclerosis is approximately $75,102 per year. 

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