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HepaGam Patient Assistance Program
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PO Box 1041, NJ 07962
Phone
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(973)656-2626
Fax:
(973)644-2361
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Eligibility
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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
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Call to have application faxed. Application may be returned via fax or mail. Healthcare provider will be notified of decision via fax within 48hrs. |
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Required
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Medically appropriate condition/diagnosis required. Doctor must complete and sign application. Patient must complete application, sign, attach proof of income and any insurance information. |
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Supply
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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. |
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Ship To
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Medication will be shipped o Doctor's office, hospital or pharmacy within 3-5 business days. |
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Note
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No online application available. |
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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.
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| HepaGam B |
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