Guide to Coverage and Reimbursement
Biogen offers full assistance throughout the coverage and reimbursement process
- Patients who are prescribed TYSABRI® (natalizumab) may already meet step-therapy requirements because they may be converting from other medications
- For the majority of insured lives, TYSABRI requires only a single step or no step at all1
- For patients who have not met the step requirement, payers typically have a pathway for earlier use through the medical exceptions process1
- Research with multiple health plans indicates that medical exceptions for TYSABRI are typically approved, provided that an appropriate clinical justification is communicated1
Biogen is committed to providing coverage and reimbursement support to physician offices and infusion sites that administer TYSABRI® (natalizumab)
GUIDE TO COVERAGE & REIMBURSEMENT
TYSABRI Coverage and Reimbursement Guide
You can click to download guide below, which is designed to provide information that can help practice administrators and other key practice staff understand the administrative needs and various aspects of the reimbursement process.
The guide includes the following topics
- Prescribing TYSABRI
- Information to help get started including enrolling your office and patients in the TOUCH® Prescribing Program, helping patients understand their insurance coverage, and completing payer prerequisites (prior authorizations, precertifications, and letters of medical necessity)
- Ordering TYSABRI
- Options for procuring TYSABRI are located here
- Billing and claims filing for TYSABRI
- Information for both physician offices and hospital outpatient/infusion sites, including key billing codes, payer coverage, payment for drugs/services, and claims denials/appeals
- Patient support
- Information on programs available to appropriate patients who require assistance with the costs associated with TYSABRI
- Healthcare reform
- An overview of the ACA, questions your patients may have regarding coverage from the health insurance marketplace, and questions your patients may ask your office
- FAQs and Glossary
- Answers to some Frequently Asked Questions and a Managed Care Glossary to help remind you of some common terms
Click here to download the full TYSABRI Coverage and Reimbursement Guide.
See downloadable resources and sample forms that your office might find useful below.
Below are downloadable resources and sample forms that your office may find useful while navigating the reimbursement process.
BILLING AND CLAIMS FILING RESOURCES
Billing and Claims Filing for TYSABRI
Below are downloadable resources and sample forms that your office may find useful for billing and filing claims for TYSABRI.