Dosage & Administration Drug label Prior authorization Financial assistance

Tysabri

(natalizumab)

Tysabri 300 MG in 15 ML Injection

Dosage & administration

* 300 mg infused intravenously over one hour, every four weeks. Do not give as an intravenous push or bolus
* TYSABRI solution must be administered within 8 hours of preparation
* Observe patients during all infusions. Post-infusion, for the first 12 infusions, observe patients for one hour after the infusion is complete. For patients who have received 12 infusions without evidence of a hypersensitivity reaction, observe patients post-infusion for the 13th and subsequent infusions according to clinical judgment.
* In CD, discontinue in patients that have not experienced therapeutic benefit by 12 weeks of induction therapy, and in patients that cannot discontinue chronic concomitant steroids within six months of starting therapy

drug label

Tysabri prescribing information

Contact Medical Science Liaison Report Adverse Event

prior authorization

Tysabri prior authorization resources

Most recent Tysabri prior authorization forms

View By Payer

Updated: Jun 04, 2023Blue Cross Blue Shield of Michigan - FEP Tysabri Prior Authorization Form (Medical Benefit)

Updated: May 31, 2023Cigna - Tysabri Prior Authorization Form

Updated: May 29, 2023Blue Cross Blue Shield of Michigan - Tysabri Prior Authorization Form (Medical Benefit)

Updated: May 24, 2023Aetna - Tysabri Prior Authorization Form

Updated: May 24, 2023Aetna - Medicare Part B Tysabri Prior Authorization Form

OTHERCoverage Authorization Appeals

OTHERLetter of Medical Necessity - Treatment Naive

OTHERLetter of Medical Necessity - Currently On Treatment

OTHERLetter of Medical Necessity - Change of Treatment

OTHERLetter of Medical Necessity - Site of Care Exceptions

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Reimbursement help (FRM)

OTHERReceive Assistance from an FRM Regarding Reimbursement Information

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financial assistance

Tysabri financial assistance options

Co-pay savings program

commercial only

OTHEREnroll in Patient Savings Program

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Overview

Reduce patient OOP costs for drug (and occasionally for drug administration/infusion costs or drug-related test costs)

Patient benefit

A portion (or all) of patient OOP (deductible, copay), typically up to monthly and/or annual max

Patient eligibility

Patient must enroll or activate (may permit HCPs to enroll on patient’s behalf for HCP-administered drugs)
Generally, must have commercial insurance (rarely, may permit uninsured patients to use)
May never be used with government insurance

How to sign up

Cards may be downloadable digital cards or hard copies
Some pharmacos offer debit cards with pre-loaded copay benefit
Typically, available through multiple channels (e.g., rep to HCP to patient; pharmacy to patient; patient via website, Hub live agent, or copay vendor (live agent or IVR); patient and HCP via Hub enrollment form)
Some HCP-administered product programs permit HCPs to enroll on a patient’s behalf through via Hub form

Bridge program

commercial only

OTHEREnroll in a Bridge Program

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Overview

Provide patient immediate access to therapy during an insurance delay (typically new starts; some may cover change in insurance)
Limited time/ fill (typically 7-30 days; some may offer additional fill for continued delay up to certain limit)

Patient benefit

100% free (outside of insurance)

Patient eligibility

HCP must enroll patient
May be limited to commercially insured patients (i.e., no government beneficiaries); some programs may allow government beneficiaries

How to sign up

Typically HCP assisted enrollment (via form)

patient education

Tysabri patient education

Getting started on Tysabri

To share resource; ask patient to:

1.Pull out phone

2.Open camera

3.Scan QR code with camera

4.Tap link