Haegarda Connect QuickStart Program

Funded

About

The Haegarda Connect QuickStart Program provides essential temporary assistance for patients prescribed Haegarda who experience delays in insurance coverage. This program ensures timely access to Haegarda, offering initial and potential short-term refills, thereby supporting patient health continuity. The Haegarda Connect QuickStart Program is designed for patients with private insurance, helping them bridge any gaps in therapy while awaiting insurance resolution.

Insurance requirements: Commercially insured

Enrollment Forms

Enrollment Form

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: No

•Activation Required: No

Program Details

•HAEGARDA QuickStart is temporary assistance for those who experience a delay in insurance coverage

•First dispense includes HAEGARDA and ancillary supplies for 14 day fill

•Patient may receive up to 2 additional months of QuickStart. Refills will only be dispensed in a 14 day supply of HAEGARDA with ancillary supplies

•Refills are only authorized in the event of a delay in commercial therapy

•QuickStart Form must be submitted to HAEGARDA Connect with a completed HAEGARDA Referral Form

•HAEGARDA Referral Form is located here: https://labeling.cslbehring.com/PRODUCTDOCUMENT/US/HAEGARDA/EN/HAEGARDAReferralForm.pdf

•Fax BOTH completed forms to 8664152162

•Call 8444234273, MondayFriday, 8 AM 8 PM ET, for assistance or additional information

Enrollment Forms

Enrollment Form