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.
OR

Starting your patient on HAEGARDA with the QuickStart program? Print out and complete both the HAEGARDA Prescription Referral form AND the QuickStart Program* Form.
Step 3

Fax completed HAEGARDA Prescription Referral Form to HAEGARDA ConnectSM at 1-866-415-2162.
* Eligible patients can continue the program and receive up to 3 months of HAEGARDA at no cost. Continued supply of HAEGARDA may be extended during the commercial insurance approval process.
Additional forms
† If you need to file an appeal, whether standard or urgent, contact HAEGARDA Connect at 1-844-HAEGARDA (1-844-423-4273) to be connected with one of CSL Behring’s Field Reimbursement Managers.
HAEGARDA Connect will confirm receipt and may contact you for additional documents requested by insurer