Navigating coverage and continued treatment for SPINRAZA® (nusinersen)

Obtaining approval for your patient’s SPINRAZA treatment for spinal muscular atrophy (SMA) often requires your practice or facility to complete several steps, including conducting a thorough Benefits Investigation to determine if an authorization and/or medical exception is needed prior to treatment approval. We have developed multiple resources to assist your practice or facility in navigating the approval process for SPINRAZA access once treatment has been prescribed.

RESOURCES

SPINRAZA overview

Basic product information and clinical study overview.

SPINRAZA Product Fact Sheet

Offers a high-level overview of SPINRAZA, including the relevant product codes.

SPINRAZA Clinical Overview

Provides high-level information about the controlled and open-label studies with SPINRAZA.

RESOURCES

SPINRAZA access

Information to help you navigate the steps to product access, including prior authorizations, medical exceptions, appeals, and reauthorizations.

SPINRAZA Access Overview

Includes a step-by-step summary of the reimbursement process for SPINRAZA.

Guide to Reauthorization

Explains the process and requirements for reauthorization (renewal of authorization per health plans) for patients who have previously received SPINRAZA. 

Guide to Requesting Medical Exceptions (MEs) and Appealing Denials and Checklists

Provides guidance for submitting an ME—which may be necessary for certain patients—and for appealing a denial of coverage. 

Guide to Prior Authorization Submissions and Checklist

Details the prior authorization process and the submission of documentation to health plans to gain approval for SPINRAZA.

Guide to Benefits Investigation

Reviews the process of conducting a Benefits Investigation for a prospective patient and the ways SMA360° may be able to help.

RESOURCES

Financial assistance

Resources for copay and coinsurance programs and information on how SMA360° can help SPINRAZA patients and their caregivers. 

Financial Assistance Options for SPINRAZA Cost

Offers guidance to help patients receiving treatment and their families navigate the SPINRAZA cost. Includes information about copays, coinsurance, and the assistance provided by SMA360°.

RESOURCES

Sample letters of medical necessity

Templates that can be customized and sent to health plans to request SPINRAZA approval for certain patients with SMA.

Treatment Naive

For use when requesting coverage for new patients starting on SPINRAZA.

Appeal

For use when appealing a denial of initial coverage or reauthorization for SPINRAZA. 

Secondary Health Plan

For use when requesting coverage for SPINRAZA from a secondary health plan when attempts for primary insurance coverage have been exhausted.

Reauthorization

For use when helping to achieve reauthorization (if needed) for patients who have previously received SPINRAZA.
 

RESOURCES

Office resources

Educational and practical resources to support your office in determining patient coverage and tracking communications with health plans.

Health Plan Reference Sheet

A template your staff can use to record information from health plans that are used most frequently.

Reimbursement Tracking Log

A log that your staff can use to help keep track of the reimbursement process for your patients receiving SPINRAZA.

Benefits Investigation Worksheet

An editable form that can be used for an actual patient, as well as instructions for gathering information to determine a patient’s level of health plan coverage.

Copay Reimbursement Form

A form for your staff to complete to help eligible patients receive reimbursement through the $0 Drug and $0 Procedure Copay Programs.

Please contact your Biogen Representative to request
printed copies of the above resources

1-844-4SPINRAZA (1-844-477-4672)

Ruby
age 4

Later-onset (Type 2) SMA
treated with SPINRAZA

Ruby
age 4

Later-onset (Type 2) SMA
treated with SPINRAZA

Individual results may vary based on several factors, including severity of disease, initiation of treatment, and duration of therapy.

SMA360°™ Logo

A circle of support for your patients*

Biogen’s SMA360° support program provides services for patients and their families that address nonmedical barriers to access, including logistical assistance, insurance benefits investigations, product education, and financial assistance for eligible individuals.

*SMA360° services from Biogen are available only to those who have been prescribed SPINRAZA. SMA360° is intended for US residents only.