Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 5.
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Pfizer Patient Assistance Program

This program provides medication at no cost.

Provided by: Pfizer, Inc.

PO Box 66585
St. Louis, MO 63166-6585

TEL: 866-706-2400


FAX: 866-470-1748
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Pfizer Group A Application for Primary Care Medicines

Pfizer Group A Application for Primary Care Medicines (Spanish)

Pfizer Group B Application for Oncology and Specialty Medicines

Pfizer Group B Application for Oncology and Specialty Medicines (Spanish)

Pfizer Group C Application for Vaccines

Pfizer Group C Application for Vaccines (Spanish)

Pfizer Group D Application for Lyrica

Pfizer Group D Application for Lyrica (Spanish)

Pfizer Patient Assistance Program Medication List

 

Medications

  • antihemophilic factor (recombinant) iv (Xyntha Solofuse) IV
 

Eligibility Requirements   

Insurance Status Uninsured or Underinsured
Those with Part D Eligible? Yes
Income Varies
Diagnosis/Medical Criteria Not specified
US Residency Required? Must be residing in the US or US territory
   

Application

Obtaining Call or download
Receiving Mailed or downloaded from website
Returning Fax or mail
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Patient and Doctor are notified
Decision Timeframe Varies
   

Medication

Amount/Supply Varies
Sent To Varies
Delivery Time Varies
Refill Process Varies per medication
Limit None
Re-application New application, new documentation yearly
   

Additional Information

Pfizer also has programs that provide eligible patients with insurance, support assistance, and medicines at a savings. Contact Pfizer RxPathways for details (844-989-7284).


Updated August 18, 2017


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 5.
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Bayer Access Solutions

This program provides brand name medications at no or low cost

Provided by: Bayer HealthCare Pharmaceuticals Inc.


TEL: 800-288-8374


FAX: 800-390-1826
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Bayer Access Solutions Form

 

Medications

  • antihemophilic factor (recombinant) (Kovaltry) 
  • antihemophilic factor recombinant (Kogenate FS) 
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage for needed medication
Those with Part D Eligible? Not specified
Income Not disclosed
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must reside in the US and be under the direct care of a US physician
   

Application

Obtaining Call or download
Receiving Faxed or downloaded from website
Returning Fax from Doctor's office
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Doctor notified
Decision Timeframe Not specified
   

Medication

Amount/Supply Not specified
Sent To Doctor's office or specific site
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
Re-application Not specified
   

Additional Information

This program also provides co-pay and reimbursement assistance.

Free Trial Program: Contact Program for details


Updated March 23, 2017


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 3 of 5.
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NovoSecure

This program provides brand name medications at no or low cost

Provided by: Novo Nordisk Pharmaceuticals, Inc.

PO Box 370
Somerville, NJ 08876

TEL: 844-668-6732


FAX: 866-488-6576
Languages Spoken:

English

Program Website

 

Program Applications and Forms

NovoSecure Application (pages 3-6)

NovoSecure Eligibility and Instructions (pages 1-2)

 

Medications

  • antihemophilic factor (recombinant) vial (Novoeight) Vial
 

Eligibility Requirements   

Insurance Status Must be uninsured
Those with Part D Eligible? No
Income Not disclosed
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must be a US resident
   

Application

Obtaining Call or download
Receiving Faxed or downloaded from website
Returning Fax or mail
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply Varies
Sent To Patient's home
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
Re-application Not specified
   

Additional Information

Free Trial Program: Contact Program for details


Updated May 31, 2017


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 4 of 5.
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CSL Behring Care Coordination Center

Provided by: CSL Behring

PO Box 615011020
First Avenue
King of Prussia, PA 19406-0901

TEL: 800-676-4266


Languages Spoken:

English

Program Website

 

Program Applications and Forms

CSL Behring Care Coordination Center:Contact program

 

Medications

  • antihemophilic factor (recombinant) (Afstyla) 
  • antihemophilic factor (recombinant) vial (Helixate FS) Vial
 

Eligibility Requirements   

Insurance Status Determined case by case
Those with Part D Eligible? No
Income Not disclosed
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must be citizen or legal resident
   

Application

Obtaining Call. *See Additional Information section below
Receiving Faxed or mailed
Returning Fax
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Decision made during phone screening
Decision Timeframe Not specified
   

Medication

Amount/Supply Varies
Sent To Varies
Delivery Time Not specified
Refill Process Not specified
Limit Varies
Re-application Varies
   

Additional Information

Since drug availability changes based on inventory, call to make sure requested drug is available.

This program lists medications that may be covered under a different CSL Behring savings program: Contact Program for more details
*877-355-4447: Carimune, Hizentra & Privigen
*866-936-2472: Zemaira

The Berinert Copay BEnefit covers up to $12,000 in eligible out-of-pocket expenses per year.
Patient must be diagnosed with HAE (Hereditary Angleodema)

Assurance Program: Once enrolled in the Program, Patient will begin earning an Award Certificate for every 3 consecutive months of therapy use. Each Certificate is worth a 1-month supply of therapy (up to the maximum amount redeemable) and can be redeemed in the event of a lapse in insurance.


Updated July 27, 2017


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 5 of 5.
 

Octapharma Reimbursement

For Healthcare Professionals Only

Provided by: Octapharma USA, Inc.

121 River Street
Suite 1201
Hoboken, NJ 07030

TEL: 800-554-4440


FAX: 800-554-6744
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Octapharma Reimbursement: Contact program

 

Medications

  • antihemophilic factor (recombinant) (Nuwiq) 
 

Eligibility Requirements   

Insurance Status Not specified
Those with Part D Eligible? Not specified
Income Not disclosed
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Not specified
   

Application

Obtaining Doctor/Doctor's office must call
Receiving Sent to Doctor's office
Returning Fax from Doctor's office
Doctor's Action Complete section and sign
Applicant's Action Call for information or inform doctor that he/she is in need
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply Up to 1 month supply
Sent To Not specified
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
Re-application Not specified
   

Additional Information

This program is intended for US HEALTHCARE PROFESSIONALS and/or Professionals involved in Healthcare Reimbursement ONLY.


Updated July 28, 2017