Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 3.
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CSL Behring Support & Assistance Programs

This program provides brand name medications at no or low cost

Provided by: CSL Behring


TEL: 800-676-4266


Languages Spoken:

English, Others By Translation Service

Program Website

 

Program Applications and Forms

CSL Behring Support & Assistance Programs Forms: Contact program

 

Medications

  • antihemophilic factor-von Willebrand factor complex human injection; iv (Humate-P) Injection; IV
 

Eligibility Requirements   

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

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

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

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

Updated August 01, 2022


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 3.
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Humate-P Connect

This program provides brand name medications at no or low cost

Provided by: CSL Behring


TEL: 800-676-4266


ALT PHONE: 844-727-2752
FAX: 844-727-2757
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Humate-P Connect Enrollment Form

 

Medications

  • antihemophilic factor-von Willebrand factor complex human injection; iv (Humate-P) Injection; IV
 

Eligibility Requirements   

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

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

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

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.

Updated August 01, 2022


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

Provided by: Patient Access Network Foundation


TEL: 866-316-7263


FAX: 866-316-7261
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Patient Access Network Foundation (PAN) Application: Contact program

 

Medications

  • antihemophilic factor-von Willebrand factor complex human injection; iv (Humate-P) Injection; IV
 

Eligibility Requirements   

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

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

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

*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.

Updated August 08, 2022