Patient Assistance Programs

• Must have a current prescription for an eligible Baxter factor or bypass product
• Must have a diagnosis of Hemophilia A or B or have an inhibitor
• Must have commercial insurance
• No income requirements

• Must have a diagnosis of Hemophilia A
• Must have a private health insurance plan
• No income requirements
• Must first contact Bayer’s Factor Solutions to apply

• Must have a valid prescription for ALPROLIX or ELOCTATE
• Must have private insurance
• US prescriber and pharmacy required
• No income requirements or caps

• Must take a CSL Behring product for the treatment of von Willebrand Disease or hemophilia A
• Must currently have a private insurance plan (federal or state insurance programs are not eligible)
• Annual enrollment

• Must take an FDA approved therapy for the treatment of Factor XIII deficiency
• Must currently have insurance coverage
• Annual enrollment

• Must have a valid prescription for AlphaNine SD
• Must not have a state or federally funded healthcare plan
• Card is available for one year from date of enrollment. Eligible patients may re-enroll.

• Must have a valid prescription for ALPHANATE
• Must not have a state or federally funded healthcare plan
• Card is available for one year from date of enrollment. Eligible patients may re-enroll.

• Must be using a Novo Nordisk product for an FDA approved diagnosis
• Must have a commercial insurance plan

• Must have a prescription for Xyntha or BeneFIX
• Must not be enrolled in any public insurance programs

1-866-415-2164

1-844-873-8836

• Patient must have a prescription for PEGASYS to treat chronic hepatitis B or C
• Patient must be 18 years of age or older
• Patient must not reside or receive treatment in Vermont
• Patient must not participate in any federal or state-funded health care programs (e.g. Medicaid, Medicare)
• Patient must not participate in other charitable funding sources (e.g. Genentech Access to Care Foundation)

• Provides assistance for eligible patients without coverage for Genentech medicines and underinsured patients whose out-of-pocket costs for Genentech medicines account for greater than or equal to 10% of their annual household adjusted gross income
• Certain financial and medical criteria must also be met

• For residents of USA, Puerto Rico, Guam, and the Virgin Islands
• Co-pay coupon not valid for prescriptions eligible for reimbursement in whole or part by federal/state health care programs (e.g. Medicaid/Medicare) or for commercial health coverage that will cover entire cost of prescription

• Provides Sovaldi or Harvoni at no charge for eligible patients with no insurance coverage

• Provides assistance with out-of-pocket costs for Hepatitis C Virus prescriptions
  (Note: Program may open and close throughout the year depending on funding)

• Must have commercial insurance coverage
• Not valid for patients enrolled in Medicare or Medicaid

• Provides Olysio for patients that are uninsured
• Household income must be under 500% of Federal Poverty Level
• Not valid for patients covered by Medicare/Medicaid

• Coupon is only valid for patients with commercial insurance plans
• Not valid for Medicare/Medicaid or any other federal/state health plans
• Not valid for patients living in Massachusetts
• Valid only for patients residing in USA or Puerto Rico

• Coupon is only valid for patients with commercial insurance plans
• Not valid for Medicare/Medicaid or any other federal/state health plans
• Not valid for patients living in Massachusetts
• Valid only for patients residing in USA or Puerto Rico

• For patients with prescriptions for PegIntron or Victrelis
• Must be a US resident
• Must be uninsured or have no coverage for Merck prescription medicine
• Must meet income guidelines

• Patient must be insured
• Medication must treat HCV directly
• Patient must reside and receive treatment in USA
• Patient’s income must fall below 500% of Federal Poverty Level
• Sovaldi, Harvoni, Ribavirin, Olysio, PegIntron, Pegasys, Incivek, and Victrelis are all elgigible medictions.Call PAN if you take another medication to treat your HCV

• Patient should be insured and insurance must cover the medication for which patient seeks assistance
• Patient must have a confirmed diagnosis of Hepatitis C
• Patient must reside and receive treatment in the USA
• Patient’s income must fall below 400% of the Federal Poverty Guideline (FPG) with consideration of the Cost of Living Index (COLI) and the number in the household