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Patient Assistance Information

 
2 Programs for Betaseron (interferon beta-1b)
 
 
Betaseron Patient Assistance Program

PO Box 221349
Charlotte, NC 28222-1349
Phone : 877-836-5724
Fax: 877-744-5615
Eligibility
> The patient must meet insurance and financial guidelines that are not disclosed. The patient must also have MS.The patient must also be a US resident.
Who Can Apply
> The doctor or patient can call to request an application.
Required
> The doctor needs to complete an application, sign it and attach a prescription.The patient needs to complete an application, sign it, and attach proof of income and other requested documentation.
Supply
> A 90-day supply
Ship To
> Patient's home
Note
> The doctor or patient can call to request 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.
 
Betaseron (interferon beta-1b)
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader
 
 
The Betaseron Foundation

The Betaseron Foundation
PO Box 221349
Charlotte, NC 28222-1349
Phone : (800) 948-5777
Fax: (877) 744-5615
Eligibility
> Patients must have a confirmed diagnosis of multiple sclerosis and be U.S. residents.
Who Can Apply
> Anyone may call to initiate application process.
Required
> Patients and their prescribing physicians must submit a completed application, and income verification is required. A copy of the most recent federal tax return is preferred, with verification of any Social Security benefits received.
Supply
> As indicated by physician.
Ship To
> Physician's office.
Note
> Program participants are required to pay a program participation fee for the Betaseron provided through the foundation. Eligibility for continuation in the program will be verified periodically, and all applications must be renewed annually.
 
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.
 
Betaseron (interferon beta-1b)
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader