Contact info
- Phone
- 1-844-989-4366
Eligibility
- Patient must not have prescription coverage for the medication.
- Meet program income guidelines which are not disclosed.
- Co-payment assistance, reimbursement support, and patient assistance programs are available 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
- Not published
- US citizenship or residency required
- Not published
Not sure where your income falls? See this year's federal poverty guidelines (opens in a new tab).
Application process
- Documents to attach
- Not published
- Prescriber license number
- Not published
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Not published
Getting the medication
- Patient receives
- Medication
- Shipped to
- Provider or patient
- Supply per shipment
- Not published
- Time to first delivery
- Not published
- Refills
- Contact program for details
- Staying enrolled
- New application every 12 months
Medications covered
- BeneFIX injection (recombinant)
- Hympavzi (marstacimab-hncq)
- Xyntha (antihemophiliam factor (recombinant))