Tysabri Coverage

A board to discuss the newly-released drug Tysabri, (formerly known as Antegren) as a treatment for Multiple Sclerosis

Tysabri Coverage

Postby better2gether » Sat Jan 15, 2005 4:07 pm

Medicare Coverage Available for New MS Drug: Tysabri

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Tysabri, the new medication for the treatment of multiple sclerosis (MS), is covered by Medicare. Per the U.S. Food and Drug Administration (FDA), Tysabri is used to treat patients with relapsing forms of MS to reduce the frequency of symptom flare-ups or exacerbations of the disease.

Tysabri was approved by the FDA in November of 2004. Once ordered by a physician, it is administered once a month, intravenously, in the physician’s office. Because the medication is administered “incident to a physician’s professional services,” it is covered by Medicare Part B.

Given that Tysabri is brand new, physicians who prescribe, administer, and bill for the medication, may find that their Medicare Part B carrier is flummoxed. This confusion, however, should not deter physicians from prescribing and administering Tysabri, when it is medically reasonable and necessary.

A spokesperson for Biogen, the pharmaceutical company that makes Tysabri, told the Center for Medicare Advocacy that until Medicare devises a code for Tysabri, physicians can bill for it as a generic J code. If physicians have difficulty with this, they should contact their carrier and/or Biogen for assistance.

Most important, MS patients who need this medication should not be denied access. If Medicare coverage for the medication is denied, physicians and beneficiaries should appeal. For assistance with the appeal process, contact your local chapter of the National MS Society or call 1-800-FIGHTMS.


http://www.medicareadvocacy.org/MS_NewD ... ysabri.htm
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Postby Arron » Sat Jan 15, 2005 5:23 pm

great find... I'll get this posted on the front page.
Disclaimer: Any information you find on this site should not be considered medical advice. All decisions should be made with the consent of your doctor, otherwise you are at your own risk.
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Tysabri Coverage Resources & Infusion Centers

Postby better2gether » Wed Jan 19, 2005 6:33 am

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Tysabri Coverage Resources & Infusion Centers

http://www.tixx.com/Tcoverage.html
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Tysabri available to veterans

Postby better2gether » Fri Jan 21, 2005 11:17 am

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Tysabri available to veterans

Question :

I would like to know if Tysabri has been added to the VHA pharmaceutical formulary? If not, why not? I'm sure that 26,000 of us are sick and tired of the 1X/wk, 3X/wk, TOD, and daily injections! A once per month infusion sounds like a Godsend!

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Answer :

Tysabri (natalizumab) is currently available to veterans with MS in the VA system. Patients need to see their MS provider to determine whether Tysabri is an appropriate treatment for them. If it is determined that it is appropriate, the provider can obtain it by completing a non-formulary request. The MS CoE's are currently working to have Tysabri added to the national VA formulary. Typically, adding a new drug to the national formulary can take 6 months or more.

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http://www.va.gov/ms/vfaq/afmviewfaq.asp?faqid=105
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Whither Goest Medicare....

Postby flora68 » Fri Jan 21, 2005 11:52 am

[/quote]Medicare Coverage Available for New MS Drug: Tysabri

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Tysabri, the new medication for the treatment of multiple sclerosis (MS), is covered by Medicare.

:D Woo-hoo!

I'm not covered by Medicare, but this isn't just good news for those on Medicare or VA; this is great news for all MS patients with any kind of health insurance who want to try Tysabri.

I'm not sure everyone knows that once Medicare covers something (whether a test, a procedure, a drug or other treatment), the other insurance companies and entities almost always follow.

better2gether, thank you for posting the good news. I'm sure I'm not the only one here who's waiting for authorization to start Tysabri, and this is very encouraging. So, again, Woo-hoo :D !
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Medicare Tysabri payment limit and code available.

Postby better2gether » Mon Feb 14, 2005 4:17 pm

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Medicare Tysabri payment limit and code available.


Important Medicare Part B New Jersey News


FDA Approval for Natalizumab (TYSABRI®)

The Food and Drug Administration (FDA) issued approval for natalizumab on November 23, 2004, for treatment of patients with relapsing forms of multiple sclerosis to reduce the frequency of clinical exacerbations.

Natalizumab is a monoclonal antibody administered intravenously for a period of approximately one hour. The recommended dose is a 300 mg infusion administered once every four weeks. The payment limit for the first quarter of 2005 for natalizumab is $31.94 per 5 mg.

Claims for natalizumab should be submitted with HCPCS code J9999, with the name and dosage of the drug listed in Item 19 of the CMS-1500 claim form or the electronic equivalent. The administration code for a one-hour infusion of natalizumab in 2005 is G0359 (chemotherapy administration, intravenous infusion technique; up to one hour, single or initial substance/drug). For services provided from November 23, 2004 through December 31, 2004, the correct administration code is 90780.

Posted: 02/07/2005

http://www.empiremedicare.com/news/njne ... 705fda.htm
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