Natalizumab Products (Tysabri, Tyruko)

Natalizumab (Tysabri, Tyruko) is covered for adults ≥18 as monotherapy for relapsing forms of multiple sclerosis and for induction/maintenance of moderately-to-severely active Crohn’s disease with evidence of inflammation after failure or intolerance to conventional therapies including TNF‑α inhibitors; use in patients <18 or for non‑indicated conditions is excluded. Coverage requires specialist prescribing/consultation (neurologist for MS, gastroenterologist for Crohn’s), documented prior therapy trials (≥1 DMT or documentation of highly‑active MS; ≥2 prior biologics for Crohn’s with biosimilars of the same molecule counting as one), adherence to recommended dosing (300 mg IV every 4 weeks), and objective evidence of clinical benefit for reauthorization (MS: after ≥1 year with MRI/EDSS/NEDA or other objective measures; Crohn’s: after ≥6 months with objective markers or symptom improvement).

"MS initial therapy requirement: Patient must have a relapsing form of MS and must either have experienced inadequate efficacy or significant intolerance to at least one disease-modifying agent for ..."