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 or Lead Case Manager 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
Fax a copy of the covered individual’s insurance card (front and back) plus the completed SPINRAZA Start Form to 1-888-538-9781.
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