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Patient Assistance Information

 
 
 
The Betaseron Foundation

The Betaseron Foundation
PO Box 221349
Charlotte, NC 28222-1349
Phone : (800) 948-5777
Fax: (877) 744-5615
Eligibility
> Patients must have a confirmed diagnosis of multiple sclerosis and be U.S. residents.
Who Can Apply
> Anyone may call to initiate application process.
Required
> Patients and their prescribing physicians must submit a completed application, and income verification is required. A copy of the most recent federal tax return is preferred, with verification of any Social Security benefits received.
Supply
> As indicated by physician.
Ship To
> Physician's office.
Note
> Program participants are required to pay a program participation fee for the Betaseron provided through the foundation. Eligibility for continuation in the program will be verified periodically, and all applications must be renewed annually.
 
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