Natalizumab (Tysabri)

Tysabri is covered only for FDA‑approved relapsing forms of multiple sclerosis and moderately‑to‑severely active Crohn’s disease (patients must be ≥18 years; non‑relapsing progressive MS and pediatric use are not covered). Coverage requires specialist prescribing/consultation (MS neurologist/MS specialist for MS; gastroenterologist for CD), MS patients must have failed one DMT or meet defined "highly‑active/aggressive" criteria, CD patients must have tried ≥2 prior biologics, dosing is limited to 300 mg IV no more frequently than every 4 weeks, and approvals are time‑limited (MS: 1 year; CD initial: 3 months, reauthorization: 1 year) with documentation of response for CD reauthorization.

"Prescriber specialty requirement for CD: Tysabri must be prescribed by or in consultation with a gastroenterologist"

Sign up to see full coverage criteria, indications, and limitations.