Tysabri Coverage
Posted: Sat Jan 15, 2005 3:07 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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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
Woo-hoo!