To prescribe PLEGRIDY, simply follow these steps:
- 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, such as therapy and financial assistance support (see 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.
- Complete the rest of the Start Form.
Copy both sides of the patient’s insurance card and pharmacy benefit card, if available.
- 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.
Click to download the Start Form for our other interferon product
Biogen is committed to getting your patients started on therapy as soon as possible. In addition to the PLEGRIDY Start Form, there is a multitude of services available through Above MS™ to help ensure a successful start on treatment.
If you have any questions or want to learn more about PLEGRIDY,
please call 1-800-456-2255