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Hemophilia Premium

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Program Status

Currently Closed – We are no longer accepting or processing applications for new or renewal patients.

 

The PAN Foundation’s Hemophilia Premium fund is currently closed. As of December 11, 2017, Patient Services, Inc. is accepting applications.

Assistance Amount

$4,500 per year. Patients may apply for a second grant during their eligibility period subject to availability of funding.

 

Premium Assistance FAQs

Eligibility Criteria

  1. The patient must be getting treatment for the disease named in the assistance program to which he or she is applying.
  2. The patient must have health insurance that covers his or her qualifying medication or product. 
  3. The patient’s medication or product must be listed on PAN’s list of covered medications.
  4. The patient’s income must fall at or below 400% of the Federal Poverty Level.
  5. The patient must reside and receive treatment in the United States or U.S. territories. (U.S. citizenship is not a requirement.)
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See the list of medications covered in this program
View List  
  • Advate (antihemophilic factor (fviii) recomb, full length (alb-free))
  • Adynovate (antihemophilic factor (fviii) recombinant, full length, peg)
  • Afstyla (antihemophil. factor(fviii)recomb, single-chn, b-dm truncated)
  • Alphanate (antihemophilic factor, human/von willebrand factor, human)
  • Alphanine Sd (factor ix)
  • Alprolix (factor ix recombinant, fc fusion protein)
  • Amicar (aminocaproic acid)
  • Aminocaproic Acid (aminocaproic acid)
  • Bebulin (factor ix complex, prothrombin cplx conc(pcc) no.6, 3-factor)
  • Benefix (factor ix human recombinant)
  • Cyklokapron (tranexamic acid)
  • Ddavp (desmopressin acetate)
  • Desmopressin Acetate (desmopressin acetate)
  • Eloctate (antihemophilic factor (fviii) recombinant, fc fusion protein)
  • Feiba Nf (anti-inhibitor coagulant complex)
  • Helixate Fs (antihemophilic factor (fviii) recomb, full length (alb-free))
  • Hemofil M (antihemophilic factor, human)
  • Humate-P (antihemophilic factor, human/von willebrand factor, human)
  • Idelvion (factor ix recombinant, albumin fusion protein)
  • Ixinity (factor ix human recombinant, threonine 148)
  • Koate (antihemophilic factor, human)
  • Kogenate Fs (antihemophilic factor (fviii) recomb, full length (alb-free))
  • Kovaltry (antihemophilic factor (fviii) recomb, full length (alb-free))
  • Lysteda (tranexamic acid)
  • Monoclate-P (antihemophilic factor, human)
  • Mononine (factor ix)
  • Novoeight (antihemophilic factor viii recombinant, b-domain truncated)
  • Novoseven Rt (coagulation factor viia (recombinant))
  • Nuwiq (antihemophilic factor viii rec hek cell, b-domain deleted)
  • Obizur (antihemophilic factor viii, recombinant porcine sequence)
  • Profilnine (factor ix complex, prothrombin cplx conc(pcc) no.4, 3-factor)
  • Recombinate (antihemophilic factor viii, human recombinant)
  • Rixubis (factor ix human recombinant)
  • Stimate (desmopressin acetate)
  • Tranexamic Acid (tranexamic acid)
  • Wilate (antihemophilic factor, human/von willebrand factor, human)
  • Xyntha (antihemophilic factor (factor viii) recomb, b-domain deleted)
  • Xyntha Solofuse (antihemophilic factor (factor viii) recomb, b-domain deleted)

Diagnosis Codes:

ICD-10: D66, D67, D68.1, D68.31

 

Resource Organizations: