Plegridy

Drug - Plegridy™, Plegridy™ Pen (peginterferon beta 1a) [Biogen Idec Inc.]

April 2015

Therapeutic area - Multiple sclerosis

Criteria

• Patient has a diagnosis of a relapsing form of multiple sclerosis
• Patient has had trials of two of the following: Betaseron, Rebif  and Copaxone

Quantity limit

1 ml per 28 days

Questions?

MHCP Provider Call Center 651-431-2700 or 800-366-5411