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Program Details

EMD SERONO
MS Lifelines

Rebif subcutaneous (interferon beta-1a)
 
CONTACT INFO
Address:
,
Phone: 1-877-447-3243 Provider Phone:
Fax: Website: Program website
ELIGIBILITY
Eligibility Info:
  • Patient must have a relapsing form of MS.
  • Eligibility determined on case-by-case basis.
  • Patient must call for a prescreening.
  • Income at or below: Not Published
    Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: Not Published
    US citizenship/residency specified: Yes
    APPLICATION
    Attachments Required: Financial
    Physician License #
    Required:
    Not Published
    Prescriber Signature
    Allowed:
    Not Published
    Application may be
    faxed:
    No
    Eligibility determination
    letter sent:
    Patient
    MEDICATION
    Receives: Medication
    Shipped To: Patient
    Quantity in Shipment: Not Published
    Delivery Time: 0-1 week
    Re-application Policy: New application every 12 months
    New financial information every 12 months
    Refill Policy: Program will contact patient to arrange for refills.
    Other Information:

    Last Updated: 01/30/2024

     

     

     


    Application Forms
    & Instructions

    The following documents are provided in interactive PDF format, allowing you to type information directly into the form.



     

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