Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 3.
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Tysabri

Patient Access Network Foundation (PAN)

This is a copay assistance program.

Provided by: Patient Access Network Foundation

PO Box 221858
Charlotte, NC 28222-1858

TEL: 866-316-7263


FAX: 866-316-7261
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

PAN Brochure

PAN Eligibility Criteria and Benefit Cap Information

PAN Proof of Expenditure Form

 

Medications

  • Tysabri (natalizumab)
 

Eligibility Requirements   

Insurance Status Must have insurance
Those with Part D Eligible? Determined case by case
Income At or below 500% of FPL
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must reside and receive treatment in US
   

Application

Obtaining Call or complete online
Receiving Sent out or may be completed online
Returning Fax, mail or submit online
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Complete section and sign
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe Within 48 hours
   

Medication

Amount/Supply Not applicable
Sent To Patient sent card to be used at pharmacy
Delivery Time Once approved; shipped same day
Refill Process Patient presents voucher/card to pharmacy for each refill
Limit None
Re-application New application every 12 months
   

Additional Information

Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly.

Updated July 10, 2015


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 3.
Scroll down to see them all.
 

Tysabri

The Free Drug Program

This program provides medication at no cost.

Provided by: Biogen

5000 Davis Drive
PO Box 13919
Research Triangle Park
Morrisville, NC 27709

TEL: 800-456-2255


Languages Spoken:

English

Program Website

 

Program Applications and Forms

 The Free Drug Program: Contact program

 

Medications

  • Tysabri vial; single-use (natalizumab)
 

Eligibility Requirements   

Insurance Status Must be uninsured or underinsured
Those with Part D Eligible? Yes
Income Not disclosed
Diagnosis/Medical Criteria Relapsing form of MS
US Residency Required? Must reside in the US
   

Application

Obtaining Applicant must call for prescreening
Receiving There is no application
Returning Not specified
Doctor's Action Fax in prescription
Applicant's Action Provide information and proof of income
Decision Communicated Decision made during phone screening
Decision Timeframe Not specified
   

Medication

Amount/Supply Not specified
Sent To Not applicable
Delivery Time Not specified
Refill Process Company contacts patient to arrange
Limit None
Re-application Company contacts patient about reapplying
   

Additional Information

Patients will be referred to a financial assistance counselor. Decisions made on a case by case basis. Program assistance can range from a temporary need up to a 1 year enrollment period. For Avonex, Tecfidera and Plegridy: up to a 90-day supply is sent to the doctor's office or the patient's home. For Tysabri: a one month supply is sent to the doctor's office or site of care for administration of the infusion.

Insurance benefits, claims assistance and/or other reimbursement help is offered.
Updated July 15, 2015


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 3 of 3.
 

Tysabri

Biogen Copay Assistance Program

This is a copay assistance program.

Provided by: Biogen

5000 Davis Drive
PO Box 13919
Research Triangle Park
Morrisville, NC 27709

TEL: 800-456-2255


Languages Spoken:

English

Program Website

 

Program Applications and Forms

 Biogen Idec Copay Assistance Program: Contact program

 

Medications

  • Tysabri vial; single-use (natalizumab)
 

Eligibility Requirements   

Insurance Status Must not have public insurance, may have private insurance
Those with Part D Eligible? No
Income No limits
Diagnosis/Medical Criteria Relapsing form of MS
US Residency Required? Must reside in the US
   

Application

Obtaining Applicant must call for prescreening
Receiving There is no application
Returning Not applicable
Doctor's Action Fax in prescription
Applicant's Action Provide information and proof of income
Decision Communicated Decision made during phone screening
Decision Timeframe Decision made during phone screening
   

Medication

Amount/Supply Not specified
Sent To Not applicable
Delivery Time Not specified
Refill Process Pharmacy contacts patient
Limit None
Re-application New application yearly
   

Additional Information

Patients will be referred to a financial assistance counselor. Decisions made on a case by case basis. There may be an annual cap that limits the amount of assistance that you can receive over one year, based on income. For Avonex, Tecfidera and Plegridy: up to a 90-day supply is sent to the doctor's office or the patient's home. For Tysabri: a one month supply is sent to the doctor's office or site of care for administration of the infusion. During conditional approval, medication will be covered as per program guidelines.

Insurance benefits, claims assistance and/or other reimbursement help is offered.
Updated July 15, 2015