Program Details

HEMA BIOLOGICS
HEMA Biologics Cares

Sevenfact (coagulation factor VIIa (recombinant)-jnew)
 
CONTACT INFO
Address: 270 Cramer Creek Court
Dublin, OH 43017
Phone: 1-855-718-4362 Provider Phone:
Fax: 1-833-390-1379 Website: Program Website
ELIGIBILITY
Eligibility Info:
  • Patient must be uninsured.
  • Patients with Medicare Part D may apply if Part D does not allow or pay for any part of medication. Patients in the donut hole do not qualify.
  • Program also provides co-pay assistance.
  • Income at or below: Single 400 % FPL
      Couple 400 % FPL
    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: Yes
    APPLICATION
    Attachments Required: Financial
    Physician License #
    Required:
    State
    NPI
    Prescriber Signature
    Allowed:
    Physician
    Application may be
    faxed:
    Yes
    Eligibility determination
    letter sent:
    Both Provider and Patient
    MEDICATION
    Receives: Medication
    Shipped To: Patient
    Quantity in Shipment: Not Published
    Delivery Time: Not Published
    Re-application Policy: New application every 12 months
    New financial information every 12 months
    Refill Policy: Not Published
    Other Information:

    Last Updated: 04/04/2024


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