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: 1-888-538-9781
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:
Discuss the benefits and risks of SPINRAZA with appropriate patients. Download the brochure below to help start the conversation.