START SMART WITH HAEGARDA
To help get patients started on HAEGARDA faster:
- Follow the steps below. We recommend that you print and fill out the forms below prior to your patient’s visit in case additional information from their insurance company is requested
- If you have any questions, contact HAEGARDA ConnectSM at 1-866-415-2162
Complete patient start forms (Prescription and Referral form and QuickStart form, if applicable*)
To enroll your patients, download the PDF below and complete the Prescription and Referral form on page 1.
If they're eligible, you can also enroll them in the
QuickStart Program
The HAEGARDA QuickStart Program provides eligible patients with access to HAEGARDA at no cost during the commercial insurance approval process.
by filling out the QuickStart form (optional) on page 2 of the PDF.
Get the Prior Authorization Checklist
Print out the Prior Authorization Checklist to verify you have diagnostics insurers often require.
Fax in the forms
Fax completed forms to HAEGARDA Connect at 1-866-415-2162.
HAEGARDA Connect will confirm receipt and may contact you for additional documents requested by insurer.
* 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.