Help your patients begin treatment and access support

for SPINRAZA

SPINRAZA Start Form:

There are 2 ways to complete the Start Form for SPINRAZA:

Download in English or Spanish here:


OR


Complete the E-sign Start Form

Using either form, complete the healthcare provider section to prescribe SPINRAZA and enroll your patient in support services.

Send the completed Start Form and copies of the insurance/pharmacy benefit cards to Biogen by fax or email.

Fax Icon

Fax: 1-888-538-9781

Email Icon

Email as an attachment: StartForm@biogen.com
Please note this email address is an unattended inbox and is for Start Forms only.

Once Biogen receives the SPINRAZA Start Form, a SPINRAZA Family Access Manager (FAM) or Lead Case Manager (LCM) will contact the patient or parent/guardian to help them navigate the process.

Remember to conduct the following laboratory tests at baseline and prior to each dose of SPINRAZA and as clinically needed:

  • Platelet count
  • Prothrombin time; activated partial thromboplastin time
  • Quantitative spot urine protein testing
SPINRAZA Patient Brochure:

Discuss the benefits and risks of SPINRAZA with appropriate patients. Download the brochure below to help start the conversation.

Biogen takes the confidentiality of personal information seriously.

The benefits for patients of granting consent include:

  • Expediting enrollment into SMA360°™* patient support services from Biogen, which includes help in areas such as treatment logistics, insurance, and financial assistance
  • Giving Biogen access to the status of the prescription should assistance be required

*SMA360° services from Biogen are available only to those who have been prescribed SPINRAZA. SMA360° is intended for US residents only.

Questions about support or treatment logistics?

Contact your Biogen Rare Disease Account Executive


SPINRAZA should be administered by, or under the direction of, a specially trained healthcare professional able to perform lumbar punctures1