Getting your relapsing MS patients started with PLEGRIDY

When you have a patient who is ready to start on PLEGRIDY, you can prescribe online or download a PLEGRIDY Start Form, complete it, and fax it to 1-855-474-3067.

To prescribe PLEGRIDY, simply follow these steps:

1

Have your patient read the Patient Consent Information and request that the patient sign the accompanying areas on the Start Form.

Signing BOTH consent lines will expedite your patient’s enrollment in Biogen Support Services, which offers financial and insurance assistance (see our patient website, PLEGRIDY.com, for eligibility guidelines). Biogen takes your patient’s confidentiality very seriously. In addition, with both signatures Biogen will have access to your patient’s prescription status should you or your patient need assistance.

2

Complete the rest of the Start Form.

Copy both sides of the patient’s insurance card and pharmacy benefit card, if available.

3

Give your patient the Instructions for Patients and Patient Consent Information pages.

If you have completed a printed Start Form, fax the Start Form to 1-855-474-3067. Printed Start Forms are valid only when received via fax. The Start Form can also be completed online.

Biogen is committed to getting your patients started on therapy as soon as possible. In addition to the PLEGRIDY Start Form, there are a multitude of services available through Biogen Support Services to help ensure a successful start on treatment. Biogen Case Managers, who will reach out to your patients once they are prescribed PLEGRIDY, are available Monday-Friday, from 8:30 AM to 8 PM ET, at 1-800-456-2255.

Biogen and iAssist have partnered to support your prescribing preference. If your office prefers printed Start Forms, you may continue to fax them to 1-855-474-3067. If you would like to learn more about ePrescribing PLEGRIDY through iAssist, please visit iAssist.com.

aiAssist is certified by Surescripts®.

If you have any questions or want to learn more about PLEGRIDY, please call 1-800-456-2255.