Natalizumab (Tysabri)

Natalizumab (Tysabri) is covered only for adults (≥18) for FDA‑approved indications — relapsing forms of multiple sclerosis (not non‑relapsing MS) and moderately-to-severely active Crohn’s disease — and is not covered for patients <18 or for non‑indicated uses. Coverage requires specialist prescribing/consultation (neurologist/MS specialist for MS; gastroenterologist for CD), prior‑therapy criteria (MS: inadequate response/intolerance to ≥1 DMT or highly‑active MS; CD: trial of ≥2 biologics), documentation of benefit or stabilization for reauthorization, dosing limited to 300 mg IV no more frequently than every 4 weeks, and approval periods of MS: 1 year, CD initial: 6 months, CD reauthorization: 1 year (plus applicable safety checks such as JCV testing).

"FDA-approved indication: Multiple Sclerosis (MS)."

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