Program Contact Info / Application Submission
Program	Betaseron PAP
Company	Bayer
Form	Download PDF
Address	MS Pathways, PO Box 221349, Charlotte, NC 28222
Phone	877-836-5724
Fax	877-744-5615
Website	http://www.betaseronfoundation.org
Program Details
Details	A 30-day supply is shipped to the patient�s home.�Patients must contact the company to arrange for refills.�A new application with documentation is needed once a year.
Program Requirements
Information	The doctor must fill out thier section, sign the application and attach a valid prescription.�The patient must fill out their section, sign the application and attach proof of income along with any insurance information if applicable.
Details	Proof of Income required Copy of most recent tax return such as 1040, 1099 required as proof of income Letter from Doctor stating zero income required as proof of income Most recent bank statements required as proof of income Most recent check/check stub copy required as proof of income Letter from employer required as proof of income Benefits statement for Social Security, Unemployment, Veterans Benefits, Pension/Retirement required as proof of income Award Letter for Alimony/Child Support, Unemployment required as proof of income Notarized statement from patient stating zero income required as proof of income
Other Requirements	co-pay for each shipment based on individuals inco
Delivery of Medication
Ship Time	3-5 days after complete app.
Delivery Options	Can be delivered directly to the patient Can NOT be delivered directly to the doctor
Application Process
App Process	Doctors or patients can call and request an application. Applications are faxed out. Completed applications can either be faxed or mailed back.
New Applications	New applications accepted Patients can apply directly to the program Doctors can NOT apply directly to the program Advocates can NOT apply directly to the program Can NOT apply for a new application via phone Can apply for a new application via fax Can apply for a new application via mail
Refills	Refills accepted Patients can NOT apply for refills Doctors can NOT apply for refills Advocates can NOT apply for refills Can NOT apply for refills via phone Can NOT apply for refills via fax Can NOT apply for refills via mail
Re-Applications	Re-Applications accepted Patients can NOT apply for Re-Applications Doctors can NOT apply for Re-Applications Advocates can NOT apply for Re-Applications Can NOT Re-Apply via phone Can NOT Re-Apply via fax Can NOT Re-Apply via mail
Appeals	Income Appeals NOT accepted Patients can NOT apply for Income Appeals Doctors can NOT apply for Income Appeals Advocates can NOT apply for Income Appeals Hardship Appeals NOT accepted Patients can NOT apply for Hardship Appeals Doctors can NOT apply for Hardship Appeals Advocates can NOT apply for Hardship Appeals Can NOT apply for an appeal via phone Can NOT apply for an appeal via fax Can NOT apply for an appeal via mail
Eligibility
Eligibility	Patients must meet insurance and�income guidelines that are not disclosed.�They must also have MS and be a US resident.�This program has a support hotline with registered nurses and counselors who are available 24 hours a day, seven days a week. Training is also available if needed.
Limitations	Patients are NOT eligible if LIS is denied Patients are eligible with existing prescription coverage Patients are eligible if prescription is not covered Patients are eligible if prescription coverage has been exhausted Patients are eligible if they are accepting Medicare Patients are eligible if they are accepting Medicare part D Patients are eligible if the medication is not covered under Medicare Patients are eligible if Medicare coverage has been exhausted
Appeals
Conditions	Appeals will NOT consider out-of-pocket expenses Appeals will NOT consider total medical expenses Appeals may be made before the patient has been denied
Other Medications
Other  Medications  available in  this program	Betaseron SC Injection 0.25mg (1cc) (interferon be - (Generic: )