Natalizumab and Associated Biosimilar(s)

This policy covers coverage of natalizumab and its biosimilars (e.g., Tysabri, Tyruko) for monotherapy treatment of relapsing forms of multiple sclerosis (including clinically isolated syndrome, relapsing‑remitting MS, and active secondary progressive MS) and for induction and maintenance of moderately‑to‑severely active Crohn disease in adults with evidence of inflammation. Coverage is limited to HCSC members in Ohio and requires prior failure/intolerance of conventional therapies and TNF‑α inhibitors for Crohn’s, prohibits concomitant chronic immunosuppressants or TNF‑α inhibitors, mandates stopping/tapering rules (no benefit by 12 weeks, steroids tapered by month 6, etc.), and is subject to plan, state, and compendia/off‑label documentation requirements.

"Coverage for a service or supply is determined by the member's benefit plan, summary plan description, or contract."