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Patient Assistance Information

 
2 Programs for Carimune NF Injection
 
 
CSL Behring Care Coordination Center

PO Box 615011020
First Avenue
King of Prussia, PA 19406
Phone : 877-633-9521
Fax: 844-727-2757
Eligibility
> This programs Insurance requirements vary case by case. Medicare Part D patients are not eligible for this program. Income requirements for this program have not been disclosed. Patient must be citizen or legal resident.
Who Can Apply
> Call to receive application which will be faxed or mailed & must be returned via fax. Doctors action will be discussed with patient and Doctor after request is received. Patient must complete section, sign, attach a copy of proof of income. Decision will be made during phone screening process. No online application.
Required
> Medically appropriate condition/diagnosis is required.
Supply
> Amount/Supply varies. Refill process is not specified. Refill limit and re-application process varies.
Ship To
> Shipping varies between both Patient & Doctor's office.
Note
> Since drug availability changes based on inventory, call to make sure requested drug is available. This program lists medications that may be covered under a different CSL Behring savings program: Contact Program for more details The Berinert Copay Benefit covers up to $12,000 in eligible out-of-pocket expenses per year. Patient must be diagnosed with HAE (Hereditary Angleodema) Assurance Program: Once enrolled in the Program, Patient will begin earning an Award Certificate for every 3 consecutive months of therapy use. Each Certificate is worth a 1-month supply of therapy (up to the maximum amount redeemable) and can be redeemed in the event of a lapse in insurance.
 
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.
 
Carimune NF Injection
 
 
 
Patient Access Network Foundation (PAN)

PO Box 221858
Charlotte, NC 28222
Phone : (866)316-7263
Fax: (866)316-7263
Eligibility
> This is a copay assistance program for patients that have health insurance. The patient's insurance must cover the qualifying medication that they are seeking assistance for. Patient with Medicare Part D will be considered on a case by case basis. Patients must be at or below 400-500% of the federal poverty level, must have a medically appropriate diagnosis/condition and must reside and receive treatment in the US.
Who Can Apply
> Patients or healthcare providers can complete the application online or by phone.
Required
> Patients must call for information or inform their doctor that they are in need. Doctors action will be discussed with the patient and doctor after the request is received.
Supply
> Not applicable
Ship To
> Patient sent card to be used at pharmacy
Note
> *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.
 
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.
 
Carimune NF Injection
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader