Patient Assistance Programs

Company

Program

Product

Limit total

Insurance Requirements

Eligibility

Contact Information

Additional Information

Baxalta

Baxalta’s Hemophilia CoPay Program

 

$12,000

           Must have commercial insurance

 

Must use eligible Baxalta hemophilia products

1-888-229-8379

 

http://www.hematologysupport.com/

Eligible patients with private insurance receive up to $12,000 every 12 months for medication-related copayment/coinsurance

Free Trial Program

Advate

Adynovate

Feiba

Rixubis

6 doses
8 doses
6 doses
4 doses

          

For new patient thinking about starting a Baxalta treatment

http://www.hematologysupport.com/free-trial/

Only for new patients

Bayer

Bayer Access Solutions

 

$12,000

           Must have a private health insurance plan

Must have a diagnosis of Hemophilia A
- no income requirements

1-800-288-8374

 

https://www.kogenatefs.com/index.php/accessing-kogenate#copay

Must first contact Bayer’s Factor Solutions to apply, may be eligible for $0 Co-pay Program

Biogen

Co-Pay Program

ALPROLIX & ELOCTATE

$12,000

           Must have private insurance

Available to those who use ALPROLIX or ELOCTATE

ALPROLIX
855-693-5628

ELOCTATE
855-693-5628

US prescriber and pharmacy required

Free Trial Plus Program

ALPROLIX

30 days free

           For those who are uninsured or underinsured

Those with government healthcare coverage are not eligible

-Program for those who are newly prescribed

http://www.alprolix.com/resources-and-support/available-financial-support.html

 

855-692-5776

You may also be eligible to receive free ALPROLIX for up to 1 year until your healthcare coverage begins

Free Trial Plus Program

ELOCTATE

30 days free

           For those who are uninsured or with commercial insurance

Those with government healthcare coverage are not eligible

-Program for those who are newly prescribed

http://www.eloctate.com/getting-started/free-trial-plus-program

 

855-693-5628

 

Factor Access Program

ALPROLIX

ELOCTATE

 

           For those experiencing a gap in their insurance

You may be eligible between jobs, changing insurers, or if you have reached your insurance cap or annual dollar limit

http://www.alprolix.com/pdfs/MyALPROLIX_Enrollment_Form.pdf

 

855-692-5776

 

https://www.eloctate.com/myeloctate/enrollment

If eligible, your factor will be provided for free

CSL Behring

MyAccess Cost-Share Program

 

$12,000

           Must currently have a private insurance plan (federal or state insurance programs not eligible)

Must take CSL Behring eligible product for the treatment of von Willebrand Disease or Hemophilia A

http://www.mysourcecsl.com/financial-support/

 

800-676-4266

Annual enrollment, must be a US resident, no financial or age restrictions apply

CSL Behring Assurance

 

Earn points to get a free month supply of factor

           Must have private insurance

For those with a current prescription for a CSL product and are using one of the following therapies:

Coagulation, Immunology, C1-Inhibitor, or Alpha-1 Therapy

www.cslbehringassurance.com

 

866-415-2164

This may only be used when there has been a lapse in your private health insurance

Patient Assistance Program

 

 

           For those uninsured or underinsured

Must currently be using a CSL Behring product

http://www.cslbehring-us.com/patient-services/patient-assistance.htm

 

844-727-2752

Can help those with insurance that does not cover their product

Emergent Biosolutions

IXINITY Savings Program

IXINITY

$12,000

           Must have commercial insurance

Must have a valid prescription for IXINITY

http://www.ixinity.com/save-on-IXINITY

 

855-494-6489

No monthly limits, no income requirements, co-pay program can be used retroactively for up to 12 months

Grifols

ALPHANATE Co-Pay Program

ALPHANATE

$20,000

           Must have commercial insurance

Must have a valid prescription for ALPHANATE

https://webrebate.trialcard.com/coupon/alphanateportal/

 

877-255-4829

No monthly maximums, prescription is covered up to the patient’s annual out-of-pocket maximum, no waiting period, no income requirements

 

Pay as little as $0 Copay Program

AlphaNine SD Card Co-Pay Program

AlphaNine

$20,000

           Must have commercial insurance

Must have a valid AlphaNine SD prescription

https://webrebate.trialcard.com/coupon/alphanineportal/

 

877-264-1405

Patient Assistance Program

 

 

Dependent on program

Must have a prescription for a Grifols product

http://www.rxassist.org/pap-info/company-detail?CmpId=235

Offers free medication to people who cannot otherwise afford their medications

Free Trial Program

Alphanate

 

AlphaNine SD

3 doses up to 12,000 IU

 

For patients who haven’t previously had a prescription or free trial of Alphanate or AlphaNine SD

http://www.alphanate.com/en/web/alphanate/patient-free-trial-program

 

http://www.alphaninesd.com/en/web/alphanine/patient-free-trial-offer

 

888-474-3657

 

Novo Nordisk

NovoSecure

NovoSeven

NovoEight

$12,000

Private insurance required for some of these benefits

Must be using a Novo Nordisk product for an FDA approved diagnosis

844-668-6732

 

https://www.mynovosecure.com/

 

Provides financial, insurance, and educational assistance as well as one-on-one access to a NovoSecure Specialist

Octapharma

Octapharma Co-Pay Assistance Program

Wilate

NUWIQ

$6,000

$12,000

           Must have commercial insurance

Must currently use a factor product from Octapharma & may only be applied to copayments, deductibles, and co-insurance costs

http://www.wilateusa.com/

 

800-554-4440

Must reside in the USA, not eligible for patients on federal or state medical programs

Wilate Bridge Program

Wilate

5,000 IUs

          

This program is for patients not currently using Wilate who would like  to receive a free trial

http://www.wilateusa.com/index.php/bridge-program-94

 

877-794-5283

This form must be completed with a physician

Pfizer

Pfizer RxPathways

 

$10,000

           For privately insured patients, uninsured, or those lacking coverage

Patients can check their eligibility online to see what services are available

www.pfizerrxpathways.com

 

877-744-5675

Provides copay assistance for privately insured and free medicine for patients without insurance or those lacking coverage

Pfizer Factor Savings Card

Xyntha

BeneFIX

$12,000

         

Must have a prescription for Pfizer products

http://www.hemophiliavillage.com/hemophilia-resources-support

 

888-240-9040

This card can be used to help cover copay, deductible, and coinsurance costs.

Pfizer Trial Prescription Program

Xyntha Solofuse

 

BeneFIX

One month supply up to 20,000 IU

           For first-time use by commercially insured patients

For newly prescribed patients

http://www.hemophiliavillage.com/hemophilia-resources-support

 

888-327-7787

Those eligible will have factor delivered at no cost


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