Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
Program 1 of 3. Scroll down to see them all. |
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CSL Behring Support & Assistance ProgramsThis program provides brand name medications at no or low cost @if> |
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Provided by: CSL Behring |
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TEL: 844-727-2752 |
Languages Spoken:
English, Others By Translation Service |
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Program Applications and Forms |
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CSL Behring Support & Assistance Programs Forms: Contact program |
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Medications |
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Eligibility Requirements |
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Insurance Status | Determined case by case | ||
Those with Part D Eligible? | Contact program for details. | ||
Income | Based on FPL | ||
Diagnosis/Medical Criteria | FDA-approved diagnosis | ||
US Residency Required? | Must reside in the US | ||
Application |
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Obtaining | Call or download | ||
Receiving | Varies | ||
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 | Not specified | ||
Decision Timeframe | Varies | ||
Medication |
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Amount/Supply | Contact the program for more details. | ||
Sent To | Varies | ||
Delivery Time | Varies | ||
Refill Process | Varies per medication | ||
Limit | Varies | ||
Re-application | Varies | ||
Additional Information |
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Since drug availability changes based on inventory, call to make sure requested drug is available. |
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Updated April 14, 2023 |
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
Program 2 of 3. Scroll down to see them all. |
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Humate-P ConnectThis program provides brand name medications at no or low cost @if> |
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Provided by: CSL Behring |
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TEL: 800-676-4266ALT PHONE: 844-727-2752 FAX: 844-727-2757 |
Languages Spoken:
English |
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Program Applications and Forms |
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Humate-P Connect Enrollment Form |
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Medications |
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Eligibility Requirements |
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Insurance Status | Determined case by case | ||
Those with Part D Eligible? | Contact program for details. | ||
Income | Based on FPL | ||
Diagnosis/Medical Criteria | Medically Necessary as determined by a Doctor | ||
US Residency Required? | Must be residing in the US or US territory | ||
Application |
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Obtaining | Call or download | ||
Receiving | Faxed, emailed, mailed or downloaded | ||
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 | Patient and Doctor are notified | ||
Decision Timeframe | Not specified | ||
Medication |
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Amount/Supply | Varies | ||
Sent To | Varies | ||
Delivery Time | Contact Program for Details | ||
Refill Process | Contact program for details. | ||
Limit | Contact the program for details | ||
Re-application | Contact program for details. | ||
Additional Information |
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Co-payment assistance, reimbursement support, patient support, and patient assistance programs are available for eligible patients. Program provides medically necessary therapy to qualified individuals who are uninsured, underinsured, or unable to afford their therapy. |
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Updated April 12, 2023 |
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
Program 3 of 3. | |||
Patient Access Network Foundation (PAN)This is a copay assistance program @if> |
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Provided by: Patient Access Network Foundation |
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TEL: 866-316-7263FAX: 866-316-7261 |
Languages Spoken:
English, Spanish, Others By Translation Service |
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Program Applications and Forms |
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Patient Access Network Foundation (PAN) Application: Contact program |
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Medications |
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Eligibility Requirements |
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Insurance Status | *See Additional Information section below | ||
Those with Part D Eligible? | Determined case by case | ||
Income | Between 400-500% of FPL | ||
Diagnosis/Medical Criteria | FDA Approved Diagnosis - See Program Website for Details | ||
US Residency Required? | Must reside and receive treatment in US | ||
Application |
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Obtaining | Call or complete online | ||
Receiving | Complete online or by phone | ||
Returning | Not applicable | ||
Doctor's Action | Varies | ||
Applicant's Action | Call for information or inform doctor that he/she is in need | ||
Decision Communicated | Patient and Doctor are notified | ||
Decision Timeframe | Within 48 hours | ||
Medication |
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Amount/Supply | Not applicable | ||
Sent To | Patient is sent savings card to be used at pharmacy | ||
Delivery Time | Once approved; shipped same day | ||
Refill Process | Patient presents voucher/card to pharmacy for each refill | ||
Limit | None | ||
Re-application | New application every 12 months | ||
Additional Information |
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*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance. Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly. Note: All new enrollment is now done electronically or over the phone. Contact program for details. |
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Updated May 01, 2023 |