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Program Details
BAYER HEALTHCARE PHARMACEUTICALS
Kogenate Factor Solutions
Kogenate FS
(antihemophilic factor (recombinant)
)
|
| CONTACT
INFO |
|
| Address: |
PO Box 2301333
Centerville, VA 20120 |
| Phone: |
1-800-288-8374 |
Provider Phone: |
|
| Fax: |
1-800-390-1826 |
Website: |
Kogenate FS Website |
|
| ELIGIBILITY
|
|
| Eligibility
Info: |
Patients with no insurance who require assistance for Kogenate® FS treatment, or patients who need assistance because their current insurance policy will not cover Kogenate® FS, will be considered for the program.
Patient must meet the program's financial criteria. Patient must be US citizen or legal resident of the United States.
Medicaid spend-down patients are not eligible. |
| Income at or below: |
Not
Published |
| Medical expenses
can be deducted from reported income: |
Not
Published |
| Social security
# requested on form: |
Yes |
| US citizenship/residency specified:
|
Not
Published |
|
|
APPLICATION |
|
| Attachments
Required: |
Financial
|
Physician
License #
Required: |
Both DEA and State
|
Prescriber
Signature
Allowed: |
Physician
|
Application
may be
faxed: |
Not Published |
Eligibility
determination
letter sent: |
Not Published
|
|
| MEDICATION |
|
| Receives: |
Medication
|
| Shipped To: |
Either Provider or Patient
|
| Quantity in
Shipment: |
30 days
|
| Delivery Time: |
Not Published
|
| Re-application
Policy: |
|
| Refill Policy: |
Not Published
|
| Other Information: |
Patients should call the Bayer Reimbursement HELPline at 800-288-8374 to see if they qualify for the Kogenate FS PAP. A Program Analyst will assess each patient's pecific case by walking him through a step-by-step prescreening process. During this process, the Program Analyst will examine all possibilities for that patient's treatment coverage, such as state prescription plans, Medicaid, or community programs and provide any information that is uncovered.
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Last Updated: 08/11/2010
|
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Application Forms
& Instructions
The following documents
are provided in interactive PDF format, allowing you to type information
directly into the form.
 Form (English)
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