Financial

Patient Assistance Programs

Alliance Pharmacy – Compassionate Care Program

The Alliance Pharmacy may assist in paying for costs related to a bleeding disorder.  They offer assistance for up to about $1,500.00 for copays/deductibles that are related to factor charges, ER visits due to bleeding disorder, and annual visits and lab work related to the bleeding disorder.

In order to receive this assistance two forms of income verification are required to determine whether applicant is eligible or not.  Therefore, we would need to submit copies of W-2s, Income Tax Returns, Social Security Benefits letters, pay stubs, copies of bank statements, and/or written approval/denial of unemployment or worker’s compensation.

Assistance may be offered for a number of consecutive years depending on the specific circumstances and income stays fairly consistent.  Copies of income documents must accompany an application EVERY TIME assistance is requested.  Interested individuals please contact the Hemophilia Outreach Center to apply.

Alliance Pharmacy Application

Great Lakes Hemophilia Foundation (GLHF)

GLHF may assist in paying for outstanding medical bills that are related to a bleeding disorder, insurance premiums, COBRA, and basic living expenses.  Each individual scenario is unique, but they typically offer about $1,500.00 for help with medical bills and $500.00 for basic living expenses each year that an applicant is found to be eligible.

In order to receive this assistance two forms of income verification are required to determine whether applicant is eligible or not.  Therefore, we would need to submit copies of W-2s, Income Tax Returns, Social Security Benefits letters, pay stubs, copies of bank statements, and/or written approval/denial of unemployment or worker’s compensation.

Assistance may be offered for a number of consecutive years depending on the specific circumstances and income stays fairly consistent.  Copies of income documents must accompany an application EVERY TIME assistance is requested.  Interested individuals please contact the Hemophilia Outreach Center to apply.

GLHF Application

Manufacturer Assistance Programs

*If your factor is not listed beside a manufacturer, that doesn’t necessarily mean that there isn’t a copay program available to you.  Please contact the Center if you are prescribed a different factor product than those listed below.


Bayer – Kogenate FS, Kovaltry

The Bayer Copay Program will cover up to $12,000.00 per 12 months for deductible/copay/coinsurance amounts related to clotting factor if approved for the program.  This program will backdate up to 120 days.  The phone number to apply and/or ask any questions is 1-800-288-8374.  Please call the program or go to the following link to get more specific eligibility information.
https://www.kogenatefs.com/accessing-kogenate


Bioverativ Eloctate, Alprolix

The Biogen Copay Program will cover up to $12,000.00 per 12 months for deductible/copay/coinsurance amounts related to clotting factor if approved for the program.   This program will backdate up to 120 days.  The phone numbers to apply and/or ask any questions along with the website link to see the specific information regarding eligibility are as follows:

Alprolix- 855-692-5776
https://www.alprolixpro.com/en_us/home/for-your-patients/ALPROLIX-patient-resources.html

Eloctate- 855-693-5628
http://www.eloctate.com/myeloctate/resources/


CSL Behring – Humate P, Helixate FS

The CSL Behring Copay Program will cover up to $12,000.00 per 12 months for deductible/copay/coinsurance amounts related to clotting factor if approved for the program.  This program does NOT backdate.  Effective eligible date is based off of the day the application is signed.  The phone number to apply and/or ask any questions is 1-800-676-4266.  Please call the program or go to the following link to get more specific eligibility information.  Link: http://www.cslbehring-us.com/patient-services/patient-assistance.htm


Grifols – Alphanate, Alphanine

The Grifols Copay Program allows for a $0.00 copay with a maximum benefit amount of $6,000.00 for deductible/copay/coinsurance amounts related to clotting factor if approved for the program.  This program will backdate up to 90 days.  The phone number to apply and/or ask any questions is 1-844-693-2286.  Please call the program or go to the following links to get more specific eligibility information.

Alphanate
http://www.alphanate.com/en/web/alphanate/patients/learn

Alphanine
http://www.alphaninesd.com/en/web/alphanine/patientcare-program


Novo Nordisk – Novo Seven, Novo Eight

The Seven Secure Copay Program will cover up to $12,000.00 per year for deductible/copay/coinsurance amounts related to clotting factor if approved for the program.  This program will backdate up to 60 days.  The phone number to apply and/or ask any questions is 1-844-668-6732.  Please call the program or go to the following links to get more specific eligibility information.

Novo Seven
http://www.novosevenrt.com/novoseven-rt-resources-hemophilia/resources.html

Novo Eight
http://www.novoeight.com/support—resources/ProductAssistance.html


Octapharma – Wilate, Nuwiq

Wilate
The Octapharma Copay Program will cover up to $6,000.00 per year for deductible/copay/coinsurance amounts related to Wilate clotting factor if approved for the program.  This program does NOT backdate.  The phone number to apply and/or ask any questions is 1-800-554-4440.  Please call the program or go to the following link to get more specific eligibility information.
http://www.wilateusa.com/index.php?option=com_content&view=article&id=123&Itemid=149

Nuwiq
The Octapharma Copay Program will cover up to $12,000.00 per year for deductible/copay/coinsurance amounts related to Nuwiq clotting factor if approved for the program.  This program does NOT backdate.  The phone number to apply and/or ask any questions is 1-800-554-4440.  Please call the program or go to the following link to get more specific eligibility information.
http://www.nuwiqusa.com/factor-viii-patient-assistance-program/


Pfizer – Benefix, Xyntha

The Pfizer Factor Savings Card will cover up to $12,000.00 per year for deductible/copay/coinsurance amounts related to clotting factor if approved for the program.   The phone numbers to apply and/or ask any questions are 1-888-240-9040 and 855-739-4366.  Please call the program or go to the following link to get more specific eligibility information.
http://www.xyntha.com/resources


 Shire – Advate, Recombinate, Hemofil M, Adynovate, Rixubus

The Baxalta Copay Program will cover up to $12,000.00 per 12 months for deductible/copay/coinsurance amounts related to clotting factor if approved for the program.  This program will backdate up to 120 days.  The phone number to apply and/or ask any questions is 1-888-229-8379.  Please call the program or go to the following link to get more specific eligibility information.
http://www.hematologysupport.com/


*HOC makes every attempt to provide accurate information regarding patient assistance programs and resources. However, since changes may occur to program policies, we recommend that you contact the manufacturer directly for the most up-to-date information.