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Monday, December 28, 2015

CVS/Caremark Formulary Changes for Plegridy and Avonex

As some of you may have learned from correspondence received from CVS/Caremark, effective January 1, 2016, PLEGRIDY® (peginterferon beta-1a) and AVONEX® (interferon beta-1a) will be excluded from a subset of CVS/Caremark commercial health insurance plans. This change will NOT impact all patients who have CVS/Caremark health insurance. 
Therapy decisions are best left to be determined by patients and their physicians. There are actions that patients and their physicians can take to ensure that they can remain on their current therapy. Individuals impacted by CVS/Caremark’s decision can work with their physicians as follows:

  • The physician can submit a medical exception/letter of medical necessity directly to CVS/Caremark
  • If the medical exception letter is not successful, an appeal can be filed
  • During the appeal process, the patient may be eligible to receive interim doses from Biogen to ensure there is no disruption in treatment
  • If the appeal is denied, patients may be eligible for Biogen’s patient assistance programs
  • Patients that need assistance in understanding and navigating their health insurance coverage can contact Biogen Support Coordinators at 1-800-456-2255; M-F, 8:30am – 8:00pm EST
  • Through the support program, Biogen is committed to helping patients and provides support services to patients and caregivers, such as financial and insurance support, nurse educators, support coordination, and peer connections


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