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.
Offers a high-level overview of SPINRAZA, including the relevant product codes.
Provides high-level information about the controlled and open-label studies with SPINRAZA.
Includes a step-by-step summary of the reimbursement process for SPINRAZA.
Explains the process and requirements for reauthorization (renewal of authorization per health plans) for patients who have previously received SPINRAZA.
Provides guidance for submitting an ME—which may be necessary for certain patients—and for appealing a denial of coverage.
Details the prior authorization process and the submission of documentation to health plans to gain approval for SPINRAZA.
Reviews the process of conducting a Benefits Investigation for a prospective patient and the ways SMA360° may be able to help.
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°.
For use when requesting coverage for new patients starting on SPINRAZA.
For use when appealing a denial of initial coverage or reauthorization for SPINRAZA.
For use when requesting coverage for SPINRAZA from a secondary health plan when attempts for primary insurance coverage have been exhausted.
For use when helping to achieve reauthorization (if needed) for patients who have previously received SPINRAZA.
A template your staff can use to record information from health plans that are used most frequently.
A log that your staff can use to help keep track of the reimbursement process for your patients receiving SPINRAZA.
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.
A form for your staff to complete to help eligible patients receive reimbursement through the $0 Drug and $0 Procedure Copay Programs.