|
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)
|
|
|