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Patient Assistance Information

SeaGen Secure Commercial Co-insurance Assistance Program

21823 30th Dr. SE
Brothel, WA 98021
Phone : 855-473-2436 Ext 1
Fax: 855-557-2480
> Patients may have private or commercial insurance coverage but may not be a participant in federal or state-funded benefits programs. Gross family household income must be at or less than $125,000 per year. Patients must also reside permanently in the US or US territories.
Who Can Apply
> Patients or healthcare providers can call to have an application faxed or mailed. The application can also be completed online or downloaded.
> Patients must inform their doctor that they are in need. The doctors office must call.
> Not applicable
Ship To
> Doctor's office
> Income and residency documentation required.
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.
Adcetris injection
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
Download printable Form
Download printable Form
Download printable Form
(Requires Acrobat Reader