- Terms and Conditions
BEBULIN (Factor IX Complex) Nanofiltered and Vapor Heated is indicated for the prevention and control of bleeding episodes in adult patients with hemophilia B (congenital Factor IX deficiency or Christmas disease).
BEBULIN is not indicated for use in the treatment of Factor VII deficiency. No clinical studies have been conducted to show benefit from this product for treating deficiencies other than Factor IX deficiency.
CoPay Assistance for BEBULIN
The CoPay Assistance Program for BEBULIN may help you pay for your hemophilia B treatment, regardless of your household income. If you qualify for the program, you can:
- Save up to $12,000 every 12 months on BEBULIN*
- Receive reimbursement for the portion you pay for your medication costs
Who is Eligible?
You may be eligible for CoPay assistance if:
- You’re starting or receiving BEBULIN for hemophilia B§
- You have commercial insurance that covers medication costs for BEBULIN and allows for CoPay or coinsurance assistanceǂ
How to Sign Up
It’s easy to sign up for CoPay Assistance for BEBULIN. Just give us a call and we’ll take care of the rest.
Call 1-888-BAX-8379 (1-888-229-8379)
Mon – Fri | 8:30 a.m. to 8:00 p.m. ET
*Non-medication expenses, such as ancillary supplies or administration-related costs, are not eligible.
§Must have a current prescription for BEBULIN with an ICD9 or ICD10, as applicable, of hemophilia B.
ǂNot valid for prescriptions reimbursed, in whole or in part, by Medicaid, Medicare, Medigap, VA, DoD, TRICARE or any other federal or state healthcare programs, including state pharmaceutical assistance programs, and where prohibited by the health insurance provider or by law.
What information do I need to have when I contact you to enroll in Shire’s CoPay Assistance Program?
When you contact us to enroll in the program, we will need your name, contact information, date of birth, diagnosis, product information and insurance information. We will also need the contact information for your prescriber and the pharmacy that ships your treatment.
What are the hours for 1-888-BAX-8379 (1-888-229-8379)?
Representatives are available to help you Monday through Friday from 8:30 a.m. to 8:00 p.m. ET.
I don’t have commercial insurance. Is there an assistance program for me?
Call us at 1-888-BAX-8379 (1-888-229-8379) to learn more about programs that may be able to help you.
Do I qualify if I am insured by Medicaid, Medicare, Medigap, the Veteran’s Administration, the Department of Defense, Tricare, or another federal or state healthcare program?
Unfortunately, we are unable to provide help through our CoPay Assistance Program if you are covered by any of the programs listed above or a state pharmaceutical assistance program.
Am I allowed to request support if I need to use more than one Shire hematology product?
Yes, you are allowed to submit a claim for more than one Shire product as long as you meet all other terms and conditions and are eligible for the program. A maximum of $12,000 is available for the program over a 12-month period.
By using this program, you are certifying that:
- You meet the eligibility criteria and have read and agree to the terms and conditions of this manufacturer CoPay program
- You will not, at any time, submit any costs for the product dispensed pursuant to this program to any government healthcare program for reimbursement
- You are permitting your personal information, including name, address, phone number, email address, and information related to health insurance and treatment, to be shared with Shire and companies working with Shire for the purpose of administering this program
- You will notify your health insurance provider or other third-party payer of the use of Shire’s CoPay Assistance Program if required to do so
If you have any questions about this program, give us a call at 1-888-BAX-8379 (1-888-229-8379).
By submitting a claim for reimbursement pursuant to this manufacturer CoPay assistance program, the Pharmacy represents and warrants that:
- It has dispensed BEBULIN [Factor IX Complex], Nanofiltered and Vapor Heated to an eligible patient and in accordance with the terms and conditions of this program and the accompanying prescription
- Its participation in this program is consistent with all applicable laws and any obligations, including its contract with the applicable payer
- It will report CoPay assistance received to payers
- The entire benefit amount received will go to eligible expenses and it will not retain any portion of the benefit as payment to it for administration or ineligible expenses
For questions regarding processing, claim transmission, patient eligibility or other issues, give us a call at 1-888-BAX-8379 (1-888-229-8379).
Terms and Conditions
This manufacturer’s CoPay assistance program is not valid for prescriptions reimbursed, in whole or in part, by Medicaid, Medicare, Medigap, VA, DoD, TRICARE, or any other federal or state healthcare programs, including state pharmaceutical assistance programs, and where prohibited by the health insurance provider or by law.
Shire’s CoPay Assistance Program provides a maximum benefit of $12,000 for eligible out-of-pocket costs and expires 12 months from date of activation. Eligible costs include deductible, CoPayment, and coinsurance costs for eligible Shire factor or bypass products. Non-medication expenses, such as ancillary supplies or administration-related costs, are not eligible.
To be eligible, patients must: 1. be starting or receiving treatment with (and have current prescription for) an eligible Shire factor or bypass product with an ICD9 or ICD10, as applicable, for a diagnosis of mild, moderate, or severe hemophilia A or B, or a hemophilia A or B inhibitor; and 2. have commercial insurance that covers medication costs for Shire factor or bypass product and allows for CoPay assistance.
Acceptance of this offer must be consistent with the terms of benefits provided by patient’s health insurance provider.
If your insurance situation changes it is your responsibility to notify Shire’s CoPay Assistance Program.
Offer limited to one card per person and may not be combined with any other coupon, discount, prescription savings card, rebate, free trial, patient assistance, or other offer.
This program is only valid for residents of the United States, excluding Puerto Rico and other U.S. territories.
Shire reserves the right to change or discontinue this program at any time without notice.
This is not health insurance.
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