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Patient Assistance Information

 
1 Program for HepaGam B
 
 
HepaGam Patient Assistance Program


PO Box 1041, NJ 07962
Phone : (973)656-2626
Fax: (973)644-2361
Eligibility
> This program is intended for Patient's without prescription coverage, this includes Medicare partD. Income must be at or below 200% of FPL. US residency requirements not specified.
Who Can Apply
> Call to have application faxed. Application may be returned via fax or mail. Healthcare provider will be notified of decision via fax within 48hrs.
Required
> Medically appropriate condition/diagnosis required. Doctor must complete and sign application. Patient must complete application, sign, attach proof of income and any insurance information.
Supply
> Amount/supply varies. Doctor/Doctor's office must complete replacement form for refills. Refill limit is 6 months then a new application must be completed.
Ship To
> Medication will be shipped o Doctor's office, hospital or pharmacy within 3-5 business days.
Note
> No online application available.
 
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.
 
HepaGam B