Once you and your patient have decided to begin treatment, submit a Start Form to enroll your patient in SMA360o

A Start Form enrolls patients in Biogen support services and can be used as a prescription.*

  • Allows patient access to SMA360o—the Biogen Circle of Support that helps with:
    • Treatment logistics
    • Insurance benefits investigations
    • Financial assistance
  • Initiates contact with SMA360o specialist support personnel:
    • A dedicated SPINRAZA Family Access Manager (FAM) or Lead Case Manager (LCM) helps the caregiver and patient to navigate the process

Questions? Call 1-844-4SPINRAZA (1-844-477-4672).

Download the SPINRAZA Start Form today. 


Putting the Start Form in action

Complete the Healthcare Provider section of the Start Form. Partially completed forms may delay access to Biogen services.

*Depending on your method of procurement, the Start Form may be used as a prescription.

  • Specialty Pharmacy: Fill out the Prescription section of the Start Form. Submitting the Start Form will enroll your patients in SMA360° and a prescription will be filled by the specialty pharmacy
  • Direct Buy: Follow your usual office procedure for procuring medication. Submitting the Start Form will only enroll your patients in SMA360°
  • Unknown: If your procurement methodology is unknown, please check the corresponding box and Biogen will follow up with you

Send the completed Start Form and copies of insurance card and pharmacy benefit card to Biogen.

Fax to 1-888-538-9781 or email as an attachment to StartForm@biogen.com (this email address is an unattended inbox and is for Start Forms only).

You will be contacted by a Biogen Rare Disease Account Executive to help answer any questions you might have.

The individual with SMA or caregiver will be contacted by a SPINRAZA FAM or LCM to help navigate the process.

Follow your usual office procedure for prescribing medication. Questions? Contact your Biogen Rare Disease Account Executive at 1-844-477-4672.

Key Icon

Complete all sections of the Start Form. Partially completed forms may delay access to Biogen services.

Photo of Ruby aged 4 years old with Type 2 SMA reading a book
Ruby
age 4

Later-onset (Type 2) SMA treated with SPINRAZA

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

INDICATION

SPINRAZA is indicated for the treatment of spinal muscular atrophy (SMA) in pediatric and adult patients.

IMPORTANT SAFETY INFORMATION

Coagulation abnormalities and thrombocytopenia, including acute severe thrombocytopenia, have been observed after administration of some antisense oligonucleotides. Patients may be at increased risk of bleeding complications.

In the sham-controlled studies for patients with infantile-onset and later-onset SMA, 24 of 146 SPINRAZA-treated patients (16%) with high, normal, or unknown platelet count at baseline developed a platelet level below the lower limit of normal, compared to 10 of 72 sham-controlled patients (14%). Two SPINRAZA-treated patients developed platelet counts <50,000 cells per microliter, with the lowest level of 10,000 cells per microliter recorded on study day 28.

Renal toxicity, including potentially fatal glomerulonephritis, has been observed after administration of some antisense oligonucleotides. SPINRAZA is present in and excreted by the kidney. In the sham-controlled studies for patients with infantile-onset and later-onset SMA, 71 of 123 SPINRAZA-treated patients (58%) had elevated urine protein, compared to 22 of 65 sham-controlled patients (34%).

Laboratory testing and monitoring to assess safety should be conducted. Perform a platelet count, coagulation laboratory testing, and quantitative spot urine protein testing at baseline and prior to each dose of SPINRAZA and as clinically needed.

Severe hyponatremia was reported in an infant treated with SPINRAZA requiring salt supplementation for 14 months.

Cases of rash were reported in patients treated with SPINRAZA.

SPINRAZA may cause a reduction in growth as measured by height when administered to infants, as suggested by observations from the controlled study. It is unknown whether any effect of SPINRAZA on growth would be reversible with cessation of treatment.

The most common adverse reactions (≥20% of SPINRAZA-treated patients and ≥5% more frequently than in control patients) that occurred in the infantile-onset controlled study were lower respiratory infection and constipation. Serious adverse reactions of atelectasis were more frequent in SPINRAZA-treated patients (18%) than in control patients (10%). Because patients in this controlled study were infants, adverse reactions that are verbally reported could not be assessed. The most common adverse reactions that occurred in the later-onset controlled study were pyrexia, headache, vomiting, and back pain. Post-lumbar puncture syndrome has also been observed after the administration of SPINRAZA.

Please see full Prescribing Information for additional Important Safety Information.

As a courtesy, our full Prescribing Information is also available en Español. For prescribing decisions, please refer to official approved labeling.