Tysabri QuickStart Program

Funded

About

The Tysabri QuickStart Program offers a rapid initiation of Tysabri therapy for eligible patients. By facilitating the shipment of Tysabri to authorized infusion sites within approximately one week, the program ensures no drug cost to patients and expedites therapy commencement without delays. Tysabri QuickStart is a highly beneficial initiative designed for patients with private insurance, prescribed Tysabri for FDA-approved indications.

Insurance requirements: Commercially insured

Enrollment Forms

Enrollment Form

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: No

•Activation Required: No

Program Details

•For eligible patients, Tysabri is shipped to a TOUCHauthorized infusion site within approximately 1 week of receipt of the Prescriber/Patient Enrollment Form

•Eligible patients may receive up to 3 QuickStart doses

•Authorized infusion sites must accept free drug

•No drug cost to patients and no delays awaiting approvals

•NOTE for Prescribers: The first step in enrolling in the TOUCH Prescribing Program is receiving educational materials provided by Biogen

•1. A valid email address is needed for each of the following roles to complete the electronic Patient Enrollment Form via DocuSign:

•a. Provider: the HCP representative or office staff responsible for completing the Enrollment Form, including patient information

•b. Prescriber: the HCP responsible for signing the prescription on the Enrollment Form

•c. Patient: the patient being prescribed therapy and responsible for signing the patient sections of the Enrollment Form

•To learn more about enrolling in the TOUCH Prescribing Program, contact a Tysabri Support Specialist at Biogen, call toll free: 18004562255 MondayFriday, 8:30 AM to 8:00 PM (ET)

Enrollment Forms

Enrollment Form