The following guide lists the information we need to ensure a quick, seamless patient referral for a Tysabri treatment.
All referrals must include:
- Patient Demographics
- Supporting Clinicals (Notes and Labs)
- Provider name
- Provider signature (or electronically authenticated signature)
- Patient name
- Phone number
- Insurance information (primary and secondary if applicable)
Supporting Clinicals (Notes and Labs):
- Clinicals to support one or more of the following:
- Patient has relapsing-remitting multiple sclerosis (RRMS)
- Patient has moderately to severely active Crohn’s disease (CD) who had an inadequate response to, or was unable to tolerate, conventional CD therapies and inhibitors of TNF
- JCV results
Ready to make a referral?
Download our Tysabri Order Form.
Financial Assistance Programs
Discover your options for accessing resources and financial support.
- Coming soon