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.
Print out and complete the HAEGARDA Prescription Referral form.
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.
* 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.