START SMART WITH HAEGARDA
To help get patients started on HAEGARDA faster:
Print and fill out the forms below prior to your patient’s visit, in case additional information from their insurance company is requested.
Step 1
Step 2
Use the Prior Authorization Checklist to verify you have diagnostics insurers often require.
Step 3
Fax completed HAEGARDA Prescription Referral Form to HAEGARDA ConnectSM at 1-866-415-2162.
Additional forms
* If you need to file an appeal, whether standard or urgent, contact HAEGARDA ConnectSM at 1-844-HAEGARDA (1-844-423-4273) to be connected with one of CSL Behring’s Field Reimbursement Managers.
HAEGARDA ConnectSM will confirm receipt and may contact you for additional documents requested by insurer.