Contact info
- Phone
- 1-855-749-4363
- Fax
- 1-855-398-7634
Eligibility
- Contact program for details.
- Patients with Medicare Part D are not eligible.
- Program offers co-payment assistance, and patient assistance programs for eligible patients.
- Income limit, single
- Not published
- Income limit, couple
- Not published
- Medical expenses can be deducted
- Not published
- Social Security number asked for
- Yes
- US citizenship or residency required
- Yes
Not sure where your income falls? See this year's federal poverty guidelines (opens in a new tab).
Application process
- Documents to attach
- Proof of income
- Prescriber license number
- NPI number
- State license number
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Provider and patient
Getting the medication
- Patient receives
- Medication
- Shipped to
- Provider or patient
- Supply per shipment
- Not published
- Time to first delivery
- Not published
- Refills
- Not published
- Staying enrolled
- New application every 12 months
Medications covered
- Alprolix (Coagulation Factor IX (Recombinant), Fc Fusion Protein)
- Altuviiio (antihemophilic factor injection; iv)
- Eloctate Injection (antihemophilic factor recombinant fc fusion protein)