Program

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Program 1 of 2 Scroll down to see them all.

This program provides brand name medications at no or low cost.
Pharmaceutical Company	Bayer HealthCare Pharmaceuticals
Program Name	Betaseron Patient Assistance Program
Program Address	PO Box 221349 Charlotte, NC 28222-1349
Phone Number	877-836-5724
Fax Number	877-744-5615
Medications on Program	Betaseron SC Injection 0.25mg (1cc) (interferon beta 1b)
Application Forms	Betaseron Patient Assistance Program Betaseron Patient Assistance Program Spanish
On-line Application	No on-line application available at this time
Web Site	Click to go to program's web site
Eligibility Guidelines and Notes	The patient must meet insurance and financial guidelines that are not disclosed. meet income guidelines that are not disclosed. The patient must also have MS. The patient must also be a US resident. The support program is very detailed, including registered nurse counselors who are available 24 hours a day, seven days a week. They also provide training if needed.
Application Process	The doctor or patient can call to request an application. The application can be either faxed or mailed out upon request. The completed application can be faxed or mailed back.
Application Requirements	The doctor needs to complete an application, sign it and attach a prescription. The patient needs to complete an application, sign it, and attach proof of income and other requested documentation.
Program Details	A 90-day supply is sent to the patient's home. The patient needs to communicate with the program's pharmacy to arrange for refills. Once a year a new application with documentation is needed.
Last Updated	August 17, 2009

Program 2 of 2.

This program provides help in applying for assistance with the cost of this drug.
Pharmaceutical Company	Diplomat Specialty Pharmacy
Program Name	Diplomat's Co-Pay Assistance Navigator Program
Program Address	Attn: Funding Department 2029 S. Elms Rd., Suite D, Swartz Creek, MI 48473
Phone Number	877-977-9118 ext. 10184
Fax Number	866-418-2650
Medications on Program	Betaseron SC Injection 0.25mg (1cc) (interferon beta 1b)
Application Forms	Not Applicable
On-line Application	No on-line application available at this time
Web Site	Click to go to program's web site
Eligibility Guidelines and Notes	Individual eligibility and level of financial support is determined on a case by case basis. Medical diagnosis necessary for this program is not specified. US residency requirements are not specified. The Co-Pay Navigator is a full service program to help patients seek funding assistance for the co-pay portion of their required medications. There is no charge for this service. Physicians/physicians' offices may submit an application online at the website indicated above, or fax information as directed below.
Application Process	The physician/physician's office should fax the prescription, diagnosis, patient demographics and any insurance information to 866-418-2650 Attn: Sandy/Funding. A Patient Care Coordinator will contact the patient within 24-48 business hours.
Application Requirements	Will be discussed with the patient and physician after the initial request to the program is received.
Program Details	Not applicable.
Last Updated	August 05, 2009