| |
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 AHF Injection |
| |
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
|
| Download printable Form Application Form |
(Requires Acrobat Reader) 
|
| |
|
|