Switching to Subcutaneous Ocrelizumab for MS Could Free 883 Chair Hours in a Year

Moving patients with multiple sclerosis (MS) from intravenous to subcutaneous ocrelizumab/hyaluronidase cut per-visit costs, sharply reduced infusion chair time, and returned an estimated 3-year institutional value of $514,544 in a cost-consequence analysis presented at inSPire2026, the National Association of Specialty Pharmacy's annual meeting. The study modeled the switch across a standardized cohort of 100 patients receiving 200 annual treatments, drawing on the University of Virginia’s (UVA’s) own implementation data alongside CMS and Bureau of Labor Statistics benchmarks.

Shorter Visit and Fewer Injection-Related Reactions

Ocrelizumab, a CD20-targeted, B-cell–depleting monoclonal antibody, is a high-efficacy disease-modifying therapy for relapsing and primary progressive MS. The intravenous form (OCR-IV) typically requires 5 to 6 hours per maintenance visit, including premedication, a 3- to 4-hour infusion, and post-infusion monitoring. The subcutaneous form (OCR-SC) is administered as a roughly 10-minute injection, followed by 60 minutes of observation on the first dose and 15 minutes on subsequent doses; patients can take premedications at home. In UVA’s own data, injection-related reactions requiring active management occurred in 0.5% of OCR-SC administrations, compared with 37% for OCR-IV, and the modeled reaction-management cost per visit was $100.27 lower with the subcutaneous form.

Direct variable cost per visit dropped from $201.90 with OCR-IV to $183.60 with OCR-SC, a net savings of $18.29. Nursing labor, disposable supplies, clinic-supplied premedications, and non-nursing support staff all cost less under the subcutaneous protocol. The exception was embedded specialty-pharmacist time, which rose by $46.40 per visit, reflecting the added coordination the switch demands around patient selection, access, medication readiness, education, and follow-up.

Freed Chair Time Exceeds OCR-IV Limit

The bigger shift was in chair time. A subsequent OCR-SC visit took just 25 minutes of chair time, versus 320 minutes for OCR-IV, an 82.8% reduction that the authors estimated could free 883 chair-hours annually across the modeled cohort, equivalent to roughly 110 8-hour chair-days. In practical terms, one 320-minute OCR-IV chair block could accommodate 5 subsequent OCR-SC visits coordinated with provider follow-ups.

But the authors were explicit that this freed time isn't automatically savings: its value, estimated at $31,000 to $155,000 annually, depends on whether clinics can actually redirect that capacity to other patient care. At UVA, that reallocation is already happening.

"We're really trying to reallocate that chair time, and with UVA, we have multiple different infusion centers,” Angela Holian, PharmD, a clinical specialty pharmacist with UVA Specialty Pharmacy, said. ”… It's about a 6-hour timeframe where we have actually relieved the infusion centers of a patient for 6 hours... With our first 100 patients, we switched 56% from the IV formulation to the subcutaneous formulation.”

The study has 1 counterintuitive finding related to Medicare reimbursement. Despite OCR-SC costing less to deliver, the July 2026 CMS Medicare Part B payment limit for a labeled OCR-SC dose ($44,215.20) exceeded the OCR-IV limit ($36,582.00) by $7,633.20, or roughly 21%, largely a function of dosing math under each drug's billing code. The authors cautioned that this payment-limit figure doesn't represent acquisition cost, actual reimbursement, or institutional margin.

Holian said the gap wasn't surprising once the dosing math was accounted for. "It's not really surprising—this is really just what is publicly available, and most institutions have acquisition cost adjustments, actual reimbursement cost adjustments, and institutional margin. So the actual cost is really institution- or location-specific... with the IV and the subcutaneous, just direct milligram per-milligram cost, the IV is a smaller dose. Because the subcutaneous is a higher dose, it's going to be more just based on that alone."

Why the Patient Benefits From OCR-SC

The model estimated patients could save nearly 5 hours per visit switching from OCR-IV to OCR-SC, worth about $121 in time value using the Bureau of Labor Statistics' median hourly wage, and could potentially avoid a separate trip entirely if the injection were coordinated with a provider visit. That figure excludes travel, parking, childcare, and lost wages, which the authors noted as real but unmeasured additional burdens tied to the longer infusion visits.

Combining net operational savings with the value of freed chair and room capacity, the authors estimated $206,654 in annual institutional value and a 3-year net present value of $514,544. They were careful to frame the results as scenario-based rather than guaranteed, noting that the analysis reflects a single academic center's experience and that realized value depends on patient demand, staffing, and payer mix. Their central message: the financial and operational effects of an IV-to-SC switch shouldn't be collapsed into 1 savings number, since cost, capacity, and reimbursement move in different directions depending on whose perspective is being measured.

References

1. Holian A, Morris L, Chen E, et al. Multi-perspective cost and capacity impact analysis of transitioning from intravenous to subcutaneous ocrelizumab/hyaluronidase in an academic medical center multiple sclerosis clinic. Presented at: NASP inSPire2026; September 22-25, 2026; National Harbor, MD. OPR21.