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Important Safety Information
Do not take BETASERON® (interferon beta-1b) if you are allergic to interferon beta-1b, to another interferon beta, to human albumin, or mannitol. See additional Important Safety Information below.
The support program for anyone taking or considering BETASERON

Become a BETAPLUS member and get informative emails, helpful tools and resources, and ongoing support from an MS-trained BETA Nurse—24/7/365.

You'll also get a free treatment journal to help track your injections, just for signing up!

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BETAPLUS is a reimbursement and clinical support program provided by Bayer for BETASERON patients. To work on your behalf, Bayer needs access to your Protected Health Information (PHI). Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you must grant permission before your PHI can be disclosed.

In order to participate in BETAPLUS, you must authorize your doctors, pharmacies, and health insurance benefit providers to share your relevant PHI with Bayer, along with certain companies that work with BETAPLUS to administer the BETAPLUS program.

By signing this form, you give Bayer and the companies it works with access to information about you, including your:

  • Name, address, and telephone number
  • Relevant medical records and financial information
  • Eligibility for assistance
  • Treatment and how it is coordinated
  • Medication and when you receive it
  • Participation in the BETAPLUS program

Your PHI will only be disclosed or shared:

  • To ensure the accuracy and completeness of this form
  • To arrange for nursing services and other ongoing support, including education, training, and communication
  • To help you with reimbursement questions
  • To see if you qualify for financial or copay assistance
  • To determine your eligibility for other programs, foundations, or alternate sources of funding to help with the costs of obtaining BETASERON
  • To communicate with you, your healthcare providers, and your insurers about your treatment with BETASERON
  • To provide information on coverage and reimbursement to your healthcare providers
  • To make relevant educational materials or product information available to you
  • To evaluate healthcare provider prescribing patterns and do other sales research
  • To comply with laws

You understand that:

  • Your PHI identifies you or could be used to identify you
  • This authorization is voluntary, and you may withdraw your authorization at any time by mailing a written request to BETAPLUS, 6251 Chancellor Drive, Suite 101, Orlando, FL 32809; or faxing your request to 1-866-248-8575
  • If you revoke this authorization, it will not affect any actions your healthcare providers or your health plan may already have taken
  • Certain healthcare providers, such as pharmacies, may receive payment from Bayer in connection with the disclosure of your PHI. They may also receive payment for using and disclosing your PHI to provide you with various communications
  • Persons or entities that receive your PHI under this authorization may not be required by privacy laws (such as HIPAA) to protect the information and may share it with others without your permission, if permitted by the laws that apply to them
  • This authorization expires at the end of your participation in the Program or five (5) years after you sign it, whichever comes first
  • Your medical treatment, payments, insurance enrollment, or eligibility for insurance benefits do not depend on your signing this form
  • If you do not sign this form, you will not receive assistance through BETAPLUS

By signing up below, I acknowledge that I have read this authorization, or had it read to me, in its entirety. I authorize the use and disclosure of my Protected Health Information (PHI) as described in this form. I understand that I am entitled to receive a signed copy of this authorization.

Please read our Privacy Policy for more information.


BETASERON® (interferon beta-1b) is a prescription medicine used to reduce the number of relapses in people with relapsing forms of multiple sclerosis (MS). This includes people who have had their first symptoms of multiple sclerosis and have an MRI consistent with multiple sclerosis. BETASERON will not cure MS but may decrease the number of flare-ups of the disease.

Important Safety Information

Do not take BETASERON (interferon beta-1b) if you are allergic to interferon beta-1b, to another interferon beta, to human albumin, or mannitol.

BETASERON can cause serious side effects, including:

Liver Problems Including Liver Failure. Symptoms of liver problems may include yellowing of your eyes, itchy skin, feeling very tired, flu-like symptoms, nausea or vomiting, bruising easily or bleeding problems. Your healthcare provider will do blood tests to check for these problems while you take BETASERON.

Serious Allergic Reactions. Serious allergic reactions can happen quickly and may happen after your first dose of BETASERON or after you have taken BETASERON many times. Symptoms may include difficulty breathing or swallowing, swelling of the mouth or tongue, rash, itching, or skin bumps.

Depression or Suicidal Thoughts. Call your healthcare provider right away if you have any of the following symptoms, especially if they are new, worse or worry you: thoughts about suicide or dying, new or worse depression (sinking feeling or sadness), new or worse anxiety (feeling uneasy, nervous or fearful for no reason), trouble sleeping (insomnia), acting aggressive, being angry, or violent, acting on dangerous impulses, hallucinations, other unusual changes in behavior or mood.

Other possible serious side effects with BETASERON include:

Heart Problems. BETASERON may worsen heart problems including congestive heart failure. Symptoms of heart problems may include swollen ankles, shortness of breath, decreased ability to exercise, fast heartbeat, tightness in chest, increased need to urinate at night, not being able to lay flat in bed.

Injection Site Problems. Serious skin reactions can happen in some people including areas of severe damage to skin and the tissue below the skin (necrosis). These reactions can happen anywhere you inject BETASERON. Symptoms of injection site problems may include swelling, redness, or pain at the injection site, fluid drainage from the injection site, breaks in your skin or blue-black skin discoloration. Change your injection site each time you inject BETASERON as it will lessen the chance of you having a serious skin reaction. Avoid injecting BETASERON into an area of the skin that is sore, reddened, infected or has other problems.

Flu-like Symptoms. BETASERON can cause flu-like symptoms including fever, chills, tiredness, sweating, muscle aches when you first start to use it. These symptoms may decrease over time. Taking medicines for fever and pain relief on the days you are using BETASERON may help decrease these symptoms.

Seizures. Some people have had seizures while taking BETASERON, including people who have never had seizures before. It is not known if the seizures were related to MS, to BETASERON, or to a combination of both. If you have a seizure after taking BETASERON call your healthcare provider right away.

Blood Problems. You may have a drop in the levels of infection-fighting white blood cells, red blood cells, or cells that help you form blood clots. If drops in levels are severe, they can lessen your ability to fight infections, make you feel tired or sluggish or cause you to bruise or bleed easily.

Risk to Pregnancy:

BETASERON can harm your unborn baby. BETASERON may cause you to lose your baby (miscarry). If you become pregnant while taking BETASERON call your healthcare provider right away. You and your healthcare provider should decide if you should continue to take BETASERON.

Most Common Side Effects:

The most common side effects of BETASERON include low white blood cell count, increases in your liver enzymes, headache, increase in your muscle tension, pain, rash, problems sleeping, stomach pain, weakness. These are not all the possible side effects of BETASERON.

Tell your healthcare provider if you have any side effect that bothers you or that does not go away. Tell your healthcare provider about all the medicines you take and your medical conditions.

Please see the full Prescribing Information, Medication Guide and
BETACONNECT™ Instructions for Use for additional information and talk to your healthcare provider.