Use the SPINRAZA Start Form to become a part of the SPINRAZA Support Community
- 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.
Complete all sections of the Start Form. Partially completed forms may delay access to Biogen services.
Later-onset (Type 2) SMA treated with SPINRAZA