Ocrevus (ocrelizumab), Tysabri (natalizumab), and Tecfidera (dimethyl fumarate) are three of the most widely prescribed disease-modifying therapies for relapsing forms of multiple sclerosis, and their 2026 costs and billing pathways are almost entirely different. Ocrevus is an anti-CD20 monoclonal antibody infused intravenously every six months at an infusion center or hospital outpatient department. Tysabri is an alpha-4 integrin inhibitor, also a monoclonal antibody, infused monthly, though a subcutaneous injection option exists for some patients. Tecfidera is a small-molecule Nrf2 pathway activator taken as an oral capsule twice daily at home. Because Ocrevus and Tysabri are physician-administered biologics, Medicare bills them under Part B using HCPCS codes J2350 and J2323; Tecfidera, as a self-administered oral drug, is billed under Medicare Part D instead. That single billing distinction drives most of the cost differences described on this page.
Generic and biosimilar status is the second major cost driver. Tecfidera lost its brand exclusivity in August 2020 when the FDA approved generic dimethyl fumarate from multiple manufacturers, and the generic now sells for roughly $41 to $150 per month with a discount coupon, a discount of more than 95 percent off the brand's average wholesale price. Tysabri gained its first biosimilar, Tyruko (natalizumab-sztn) from Sandoz and Polpharma, when the FDA approved it on August 25, 2023, and it launched in the US market at roughly a 20 percent discount to brand Tysabri. Ocrevus has no generic or biosimilar as of 2026; its core US patents run through approximately March 2029, and while Amgen and Celltrion both have ocrelizumab biosimilar candidates in clinical trials, none is expected to reach the US market before 2029 at the earliest.
None of the three drugs compared here has been selected for Medicare drug price negotiation under the Inflation Reduction Act of 2022, and none carries a CMS-negotiated Maximum Fair Price as of 2026. Patients switching between Ocrevus, Tysabri, and Tecfidera for cost reasons should talk to their neurologist first; the three drugs work through different mechanisms, carry different infection and progressive multifocal leukoencephalopathy (PML) monitoring requirements, especially for Tysabri in JC virus-positive patients, and are not clinically interchangeable. The comparison table below lays out cash price, Medicare billing pathway, generic or biosimilar status, and manufacturer patient assistance program for all three drugs side by side.
What MS Drug Comparison Costs by Point of Pay (2026)
The price you pay depends almost entirely on WHERE you pay. The same ms drug comparison can cost many times more at a hospital than at your local pharmacy:
2026 MS Drug Comparison Price by Point of Pay| Where you pay | Typical cost | Notes |
|---|
| Medicare Part B ASP rate (physician-administered infusion) | $7,610 - $37,906/infusion (ASP+6%) | Ocrevus (J2350) pays about $37,906 per 600mg infusion at ASP+6%; Tysabri (J2323) pays about $7,610 per 300mg infusion at ASP+6%; Tecfidera has no Part B ASP because it is billed through Part D |
| Pharmacy counter (retail cash, Tecfidera only) | $41 - $7,200/month | Generic dimethyl fumarate with a discount coupon runs $41-$150/month; brand Tecfidera without a coupon can run close to $7,200/month at AWP-based cash pricing; Ocrevus and Tysabri are not dispensed at retail pharmacies |
| Medicare (2026, Part B for infusions, Part D for Tecfidera) | $1,522 - $7,581 per Part B infusion (20% coinsurance); Part D formulary tier copay for Tecfidera | After the 2026 Part B deductible of $283 is met, 20% coinsurance on Ocrevus runs about $7,581/infusion and on Tysabri about $1,522/infusion, unless a Medigap plan or Medicaid covers the coinsurance; Tecfidera copay counts toward the 2026 $2,100 Part D annual out-of-pocket cap |
| Commercial insurance with manufacturer copay support | $0 - $25/month or per infusion | Ocrevus Co-pay Program, Biogen's Tysabri copay program, and Biogen's Tecfidera copay card can each reduce commercially-insured cost-sharing to as little as $0; none of the three can be used by Medicare, Medicaid, TRICARE, or VA beneficiaries |
| Medicaid | $1 - $4/prescription (Tecfidera); medical benefit billing for infusions | Most state Medicaid programs bill Ocrevus and Tysabri through the medical benefit (like Medicare Part B) rather than a pharmacy copay, and often require prior authorization or step therapy through a lower-cost DMT first; generic Tecfidera typically carries a nominal $1-$4 pharmacy copay |
Medicare Part B ASP payment limits from CMS 2026 quarterly pricing files. Retail and generic prices from GoodRx 2026 data. Medicaid cost-sharing and prior authorization rules vary by state; check your state's Medicaid income limits page for household eligibility rules.
Source: CMS Medicare Part B ASP Pricing Files 2026, CMS Medicare Part D 2026 Benefit Parameters, GoodRx, manufacturer patient support programs
Why Hospitals Charge So Much
Hospital outpatient departments typically charge two to three times more than a freestanding infusion center for the identical Ocrevus or Tysabri infusion, because the hospital adds a separate facility fee on top of the drug charge itself. A single Ocrevus infusion billed at a hospital outpatient department can run $32,000 to $60,000 once the facility fee is layered on top of the roughly $16,000 to $20,000 drug-only cash price, while the same infusion at an independent, freestanding infusion center typically stays closer to the drug-only price. Tysabri follows the same pattern: a hospital-based infusion can run $15,000 to $28,500 per month versus $7,500 to $9,500 at a freestanding center. Patients who have a choice of infusion site should ask their neurology practice whether an independent infusion center is available in network, since the site-of-care decision alone can save tens of thousands of dollars per year.
Medicare Part A only covers Ocrevus or Tysabri when the infusion happens during an inpatient hospital admission, which is rare for routine MS treatment; almost all Ocrevus and Tysabri infusions are outpatient and billed under Part B instead. That means the 2026 Part B annual deductible of $283 and the standard 20 percent coinsurance apply to nearly every MS infusion a Medicare beneficiary receives, and unlike Part D, Part B has no annual out-of-pocket cap unless the beneficiary carries a Medigap supplement or has Medicaid as a secondary payer. A beneficiary on Ocrevus without supplemental coverage can face roughly $15,160 a year in Part B coinsurance alone (two infusions at about $7,581 each), and a beneficiary on monthly Tysabri can face roughly $18,260 a year (twelve infusions at about $1,522 each).
Tecfidera sits entirely outside this hospital-charge dynamic because it is a self-administered oral capsule dispensed by a retail or mail-order pharmacy and billed through Medicare Part D, not Part A or Part B. That structural difference is the single biggest reason Tecfidera is dramatically cheaper in practice for most patients than either infused biologic, independent of the drug's own clinical effectiveness for a given patient's MS subtype. Patients switching from an infused therapy to Tecfidera, generic dimethyl fumarate, or Biogen's related oral drug Vumerity (diroximel fumarate) purely for cost reasons should discuss the switch with their neurologist, since disease activity, prior treatment response, and tolerability all factor into which DMT is clinically appropriate.
HCPCS J-Codes: What Appears on Your Bill
Ocrevus and Tysabri are both billed under Medicare Part B using HCPCS Level II J-codes, since they are physician-administered infusions rather than self-administered pharmacy drugs. Tecfidera has no HCPCS J-code because it is dispensed as an oral capsule through Medicare Part D.
HCPCS J-codes for MS Drug Comparison| Code | Description | What to look for |
|---|
| J2350 | Injection, ocrelizumab (Ocrevus), 1 mg. Standard maintenance dose is 600 mg (600 billing units) infused once every 6 months; the first course splits into two 300 mg infusions two weeks apart. | Confirm the claim shows 600 units for a maintenance infusion (or 300 units for each of the two loading-dose infusions), billed at the 2026 ASP+6% payment limit of roughly $59.60-$60.97 per unit, not a flat facility rate that exceeds the Medicare-allowed amount. |
| J2323 | Injection, natalizumab (Tysabri or the Tyruko biosimilar), 1 mg. Standard dose is 300 mg (300 billing units) infused every 4 weeks. | Confirm the claim shows 300 units per monthly infusion at the 2026 ASP+6% payment limit of roughly $23.93 per unit, and check whether the biosimilar Tyruko was billed instead of brand Tysabri if your prescriber ordered the lower-cost biosimilar. |
J-codes are HCPCS Level II codes used for Medicare Part B drug billing, not NDC (National Drug Code) numbers. Ask your infusion center or hospital billing department to confirm the correct J-code and unit count appear on your Explanation of Benefits.
Source: CMS HCPCS Level II Code Set 2026, CMS Medicare Part B ASP Pricing Files 2026
Patient Assistance Programs
Genentech and Biogen each run a separate patient assistance program for their MS drug, and the income thresholds and application process differ across the three brands. If you have no insurance and a modest income, any of the three drugs may cost $0 through the correct manufacturer program, but you must apply to the manufacturer of your specific prescribed drug; there is no single combined MS drug assistance program.
Patient assistance programs for MS Drug Comparison| Manufacturer program | Cost / Benefit | How to apply |
|---|
| Genentech Patient Foundation - Ocrevus | Free Ocrevus for uninsured or underinsured patients, including some Medicare beneficiaries, with household income generally below approximately 500% FPL ($79,800 for a household of 1 in 2026) | gene.com/patients/patient-foundation |
| Biogen Support Services / Above MS - Tysabri | Free or reduced-cost Tysabri for uninsured patients with household income generally below approximately 400% FPL; the separate Biogen $0 copay card is available to commercially-insured patients but not to Medicare, Medicaid, TRICARE, or VA beneficiaries | tysabri.com/en_us/home/join-biogen-support |
| Biogen Support Services / Above MS - Tecfidera | Free or reduced-cost brand Tecfidera for uninsured patients with household income generally below approximately 400% FPL; most patients with any prescription coverage should instead ask their pharmacy about the lower-cost generic dimethyl fumarate first | abovems.com |
| NeedyMeds Drug Discount Card | Variable discount on generic Tecfidera, accepted at most US pharmacies, no income limit; does not apply to infused Ocrevus or Tysabri, which are not dispensed at retail pharmacies | needymeds.org |
Manufacturer copay cards for all three drugs (the Ocrevus Co-pay Program, Biogen's Tysabri copay support, and Biogen's Tecfidera copay card) are not available to Medicare, Medicaid, TRICARE, or VA beneficiaries by federal law (anti-kickback statute, 42 U.S.C. Section 1320a-7b). If you have any government insurance, use the manufacturer's income-based patient assistance program instead of a copay card, or apply for Medicare Part D Extra Help through Social Security at 1-800-772-1213 if you take Tecfidera.
Source: gene.com, tysabri.com, abovems.com, needymeds.org
Medicare Part D
Medicare treats these three MS drugs through two entirely different benefit structures in 2026. Ocrevus and Tysabri, as physician-administered infusions, are covered under Medicare Part B, subject to the 2026 Part B deductible of $283 and 20 percent coinsurance, with no annual out-of-pocket cap unless a Medigap plan or Medicaid covers the balance. Tecfidera, as a self-administered oral capsule, is covered under Medicare Part D instead, where cost-sharing depends on your plan's formulary tier for brand Tecfidera versus generic dimethyl fumarate, and most plans place the generic on a much lower tier with a smaller copay. All out-of-pocket Part D spending on Tecfidera counts toward the 2026 Part D annual out-of-pocket cap of $2,100; once you hit that cap across all your Part D drugs combined, you pay $0 for the rest of the calendar year.
Extra Help, the Part D Low Income Subsidy, reduces Tecfidera cost-sharing further for Medicare beneficiaries with limited income and resources. In 2026, Extra Help enrollees pay $12.65 per fill for brand Tecfidera and a smaller copay for generic dimethyl fumarate. Extra Help is generally available to beneficiaries with income at or below 150 percent of the Federal Poverty Level. There is no equivalent Extra Help program for Part B coinsurance on Ocrevus or Tysabri; Medicare beneficiaries facing high Part B coinsurance on either infusion should ask about a Medicare Savings Program through their state Medicaid agency or apply for a Medigap supplement during their Medigap open enrollment window.
Common MS Drug Comparison Billing Errors
Ocrevus and Tysabri are billed through Medicare Part B or a commercial medical benefit, while Tecfidera runs through Part D or a commercial pharmacy benefit, so billing problems for these three drugs show up in very different places. Watch for these issues:
- Infusion center or hospital bills more than the ASP+6% Medicare Part B payment limit for J2350 (Ocrevus) or J2323 (Tysabri) in 2026, which can indicate an incorrect unit count or an out-of-network facility fee; ask billing to reconcile the claim against the published CMS ASP file.
- Generic dimethyl fumarate billed at the brand-name Tecfidera price instead of the generic tier.
- Manufacturer copay card applied for a patient who has Medicare, Medicaid, TRICARE, or VA coverage, which is prohibited and can result in a claim clawback later.
- Step therapy denial requiring a trial of a lower-cost, first-line DMT before approving Ocrevus or Tysabri, without documenting that the required first-step drug was already tried and failed or is clinically inappropriate.
- Brand Tysabri billed under J2323 when the lower-cost Tyruko biosimilar was actually infused, or vice versa, which can trigger an incorrect copay or coinsurance calculation.
- Charged the standard Tecfidera copay after you already hit the $2,100 Part D annual out-of-pocket cap for the year across all your combined Part D drugs.
Frequently Asked Questions
Is there a generic or biosimilar for Ocrevus, Tysabri, or Tecfidera?
Yes for two of the three. Tecfidera has a full generic (dimethyl fumarate) available since August 2020, cutting the cost by more than 95 percent compared to brand. Tysabri has a biosimilar, Tyruko (natalizumab-sztn), FDA-approved in August 2023 and available since 2024 at roughly a 20 percent discount. Ocrevus has no generic or biosimilar as of 2026; its core US patents run through approximately March 2029.
How do I apply for the Genentech or Biogen patient assistance program?
Contact the manufacturer of your specific drug: the Genentech Patient Foundation at 1-888-941-3331 or gene.com/patients/patient-foundation for Ocrevus, or Biogen Support Services at 1-800-456-2255 or abovems.com for Tysabri or Tecfidera. Each requires proof of income, proof of US residency, a valid prescription, and documentation that you have no insurance covering that drug. Processing takes 7 to 15 business days, and approved patients typically receive a 12-month benefit that requires annual re-enrollment.
Can I use an MS drug manufacturer copay card with Medicare?
No. Federal anti-kickback law (42 U.S.C. Section 1320a-7b) bars Medicare, Medicaid, TRICARE, and VA beneficiaries from using any manufacturer copay card or manufacturer coupon, including the Ocrevus Co-pay Program and Biogen's copay cards for Tysabri and Tecfidera. Medicare patients on Tecfidera should apply for Part D Extra Help instead, and Medicare patients on Ocrevus or Tysabri facing high Part B coinsurance should apply for a Medicare Savings Program through their state Medicaid agency or the manufacturer's income-based patient assistance program.
What if my insurance denies coverage for Ocrevus, Tysabri, or Tecfidera?
Request a written denial notice, then file a formal appeal within 60 days with a neurologist's letter documenting medical necessity, relapse activity, or MRI findings. If your plan requires step therapy with a cheaper DMT first, your neurologist can file a step-therapy exception documenting contraindication, prior failure, or active disease risk. If the appeal fails, apply for the manufacturer PAP that matches your specific drug as a fallback.
Does the IRA negotiated Medicare price apply to Ocrevus, Tysabri, or Tecfidera?
No. None of the three has been selected for Medicare drug price negotiation under the Inflation Reduction Act of 2022, and none carries a CMS-negotiated Maximum Fair Price as of 2026. Ocrevus and Tysabri instead fall under standard Medicare Part B ASP-based pricing with 20 percent coinsurance, and Tecfidera falls under the general 2026 Part D annual out-of-pocket cap of $2,100 like any other non-negotiated Part D drug.
What does each MS drug cost without insurance in 2026?
Ocrevus lists near $78,858 per year, or $16,000 to $20,000 per twice-yearly infusion. Tysabri runs $7,500 to $9,500 per monthly infusion, or roughly 20 percent less with the Tyruko biosimilar. Generic Tecfidera (dimethyl fumarate) costs $41 to $150 per month with a discount coupon; brand Tecfidera without a coupon can run close to $7,200 per month at cash pricing.
Do I qualify for an MS drug patient assistance program based on my income?
It depends on which drug you take. The Genentech Patient Foundation for Ocrevus generally uses an income cutoff around 500% of the Federal Poverty Level ($79,800 for one person in 2026). Biogen Support Services / Above MS for Tysabri and Tecfidera generally uses roughly 400% FPL. Check the specific program for your prescribed drug rather than assuming one threshold applies to all three.
Is Ocrevus the same as Wegovy or Ozempic? What is the difference between Tecfidera and Vumerity?
Ocrevus is not related to Wegovy or Ozempic; it is an anti-CD20 monoclonal antibody for multiple sclerosis, while Wegovy and Ozempic are GLP-1 receptor agonists for weight management and diabetes. Vumerity (diroximel fumarate) is a related Biogen drug that converts to the same active metabolite as Tecfidera (dimethyl fumarate) but is formulated to cause less gastrointestinal upset; Vumerity has no generic as of 2026, so switching from brand Tecfidera to generic dimethyl fumarate is typically the lower-cost option unless GI tolerability is a specific concern.
