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Patient Assistance Information

 
 
 
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