Natalizumab products: Tysabri, Tyruko
Policy governs coverage, initial and renewal clinical criteria, dosing, coding, and quantity limits for natalizumab (Tysabri and biosimilar Tyruko) for Medicaid, Commercial, and Medicare members of Neighborhood Health Plan of Rhode Island.
Review dates updated through 02/17/2026 with references updated to 2025/2026 package inserts
Coverage Summary
This policy covers natalizumab products (Tysabri and biosimilar Tyruko) and is covered with criteria for Medicaid, Commercial, and Medicare members of Neighborhood Health Plan of Rhode Island. Natalizumab is an integrin receptor antagonist indicated for relapsing forms of multiple sclerosis and moderate to severe Crohn's disease, with evidence showing reductions in relapse rates and risk of disability progression in MS. The policy defines initial and renewal clinical criteria, dosing, coding, and a quantity limit of 300 billable units every 28 days.
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