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Patient Assistance Information

 
3 Programs Sponsored By Baxter Healthcare Corporation (External Link)
 
 
Ara-Assist Program

PAREXEL
5870 Trinity Parkway
Centerville, WA 20120
Phone : 800-447-3437
Fax: 888-750-1243
Eligibility
>
Who Can Apply
> The patient can call to get an application or submit an application on line.
Required
>
Supply
>
Ship To
>
Note
> The patient can call to get an application or submit an application on line.
 
 
 
 
Gammassist Program for Gammagaurd

PAREXEL
5870 Trinity Parkway
Centerville, VA 20120
Phone : 800-447-3435
Fax: 888-750-1243
Eligibility
>
Who Can Apply
> Anyone requesting assistance can call to request a faxed application or download it from the website.
Required
> The patient must fill out a section and sign the application.
Supply
>
Ship To
>
Note
> Anyone requesting assistance can call to request a faxed application or download it from the website.
 
Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
 
Gammagard S/D (immunoglobulin G)
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader
 
 
Baxter Factor Plus Program

5870 Trinity Parkway
Suite 600
Centreville,, VI 20120
Phone : 888-229-8379
Fax: 800-643-9450
Eligibility
> The patient must have no insurance and be financially unable to afford the medication. The patient must also be a US resident.
Who Can Apply
> The doctor/doctor's office should call for an application.
Required
> The doctor must fill out a section and sign the application.The patient must fill out a section, sign the application and attach proof of income.
Supply
>
Ship To
> Hospital, Doctor's office or Pharmacy
Note
> The doctor/doctor's office should call for an application.
 
Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
 
Advate Powder for Injection
Feiba VH Immuno (anti-inhibitor coagulant complex)
Feiba VH Powder
Hemofil M (albumin; polyethylene glycol)
Hemofil-M AHF Injection
Recombinate (rAHF)
Recombinate rAHF
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader