The Betaseron Patient Assistance Program
Bayer HealthCare Pha
Contact Information
The Betaseron Patient Assistance Program
PO Box 221349
Charlotte, NC 28222-1349
1-(877) 836-5724 (phone)
1-(877) 744-5615 (fax)
The Betaseron Patient Assistance Program
PO Box 221349
Charlotte, NC 28222-1349
1-(877) 836-5724 (phone)
1-(877) 744-5615 (fax)
Physician requests should be directed to:
The Betaseron Patient Assistance Program
PO Box 221349
Charlotte, NC 28222-1349
1-(877) 836-5724 (phone)
The Betaseron Patient Assistance Program
PO Box 221349
Charlotte, NC 28222-1349
1-(877) 836-5724 (phone)
How to Apply:
Select one of the links below to download the application or go to the program site for more information on how to apply. Once you fill out your application, send it to the address on the application. Do NOT send it to RxResource.
Select one of the links below to download the application or go to the program site for more information on how to apply. Once you fill out your application, send it to the address on the application. Do NOT send it to RxResource.
Eligibility:
Patients must have a confirmed diagnosis of multiple sclerosis and be U.S. residents. Patients and their prescribing physicians must submit a completed application, and income verification is required.
Patients must have a confirmed diagnosis of multiple sclerosis and be U.S. residents. Patients and their prescribing physicians must submit a completed application, and income verification is required.
Other Information:
Patients or their physicians may initiate the application process. Patients should complete the Patient Information forms, and verification of annual household income is also required. (A copy of the most recent federal tax return is preferred, along with verification of any Social Security benefits received.) The physician who is responsible for the patient's ongoing care should complete the Physician Information form. Both patient and physician information must be returned to the Betaseron Patient Assistance Program. All applicants and their physicians will be notified in writing of the eligibility determination. Support begins once an application is approved; it is not retroactive. Program participants are required to pay a program participation fee for Betaseron provided through the program. Eligibility for continuation in the program will be verified periodically, and all applications must be renewed annually.
Patients or their physicians may initiate the application process. Patients should complete the Patient Information forms, and verification of annual household income is also required. (A copy of the most recent federal tax return is preferred, along with verification of any Social Security benefits received.) The physician who is responsible for the patient's ongoing care should complete the Physician Information form. Both patient and physician information must be returned to the Betaseron Patient Assistance Program. All applicants and their physicians will be notified in writing of the eligibility determination. Support begins once an application is approved; it is not retroactive. Program participants are required to pay a program participation fee for Betaseron provided through the program. Eligibility for continuation in the program will be verified periodically, and all applications must be renewed annually.
Product(s) covered by program:
- Betaseron
