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SeaGen Secure Commercial Co-insurance Assistance Program
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21823 30th Dr. SE
Brothel, WA 98021
Phone
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855-473-2436
Ext 1
Fax:
855-557-2480
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Eligibility
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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
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Patients or healthcare providers can call to have an application faxed or mailed. The application can also be completed online or downloaded. |
Required
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Patients must inform their doctor that they are in need. The doctors office must call. |
Supply
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Not applicable |
Ship To
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Doctor's office |
Note
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Income and residency documentation required. |
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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. |
Adcetris injection |
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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)
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