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Patient Assistance Information

 
1 Program for Hemofil M (albumin; polyethylene glycol)
 
 
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.
 
Hemofil M (albumin; polyethylene glycol)
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader