If you have a lapse in coverage for ReFacto or BeneFIX because you're experiencing a temporary gap in insurance coverage, or because you've exceeded an annual or lifetime benefit maximum on your insurance for these products, this may be the program for you. If you're eligible, the Wyeth Insurance-Coverage Program not only ensures access to factor, but, just as importantly, provides the support of knowledgeable case management professionals who will help you navigate complicated insurance issues in ways that work for you.

Who Is Eligible?
You're eligible to enroll in the Wyeth Insurance-Coverage Program if you meet these requirements:

• You have hemophilia A or hemophilia B
• You have public or private insurance coverage
• You live in a state that allows the program
• You have been using ReFacto or BeneFIX for at least 3 consecutive months at the time of application

If you do not meet these requirements, learn about the Patient Assistance Program.

How It Works

• Once you've enrolled, an insurance case manager will be assigned to you
• Proof of prior usage (such as a signed statement from your doctor or your insurance company) of a Wyeth hemophilia product for at least 3 consecutive months at the time of application must be provided to the program administrator
• You must be currently covered by public or private insurance
• In the event of a lapse in your insurance coverage, you will be eligible to receive a 1-month supply of factor during such lapse, up to 12 months or a maximum of 200,000 IU
• Product will be delivered directly to you (no delivery to PO boxes)
• Coupons, certificates, or points do not have to be earned or redeemed to receive free factor
• You and your doctor will be notified by a program administrator when you reach 75% and 90% of your program limit
• If you reach the maximum amount of product allowed under the Wyeth Insurance-Coverage Program and have not found new insurance coverage, you may apply to the Wyeth Patient Assistance Program

How to Enroll
You can enroll by downloading an enrollment form or by contacting the Wyeth Hemophilia Hotline at 1-888-999-2349 weekdays from 9:00 a.m. to 5:00 p.m. Eastern time.

• Press option 1 to be connected to the Wyeth Factor Resource Program^TM
• Then press 1 for the Insurance-Coverage Program
• Enrollment forms must be completed, signed, and mailed or faxed to the program administrator. The mailing address and the fax number are printed on the enrollment form

Click here to download and print an enrollment form for the Wyeth Insurance-Coverage Program.

This document is in PDF (portable document format). PDF files require Adobe® Reader®; click here to download this free program.

• The health care provider or the provider's office must complete the "Physician Information" and "Product Utilization" sections on the enrollment form. Your provider must sign the form and return it to you.

Indication
BeneFIX is indicated for the control and prevention of hemorrhagic episodes in patients with hemophilia B (congenital factor IX deficiency or Christmas disease), including control and prevention of bleeding in surgical settings. BeneFIX is not indicated for the treatment of other factor deficiencies (eg, factors II, VII, VIII and X) nor the treatment of hemophilia A patients with inhibitors to factor VIII, nor the reversal of coumarin-induced anticoagulation, nor the treatment of bleeding due to low levels of liver-dependent coagulation factors.

Important Safety Information

	•	As with the intravenous administration of any protein product, common adverse reactions may include headache, fever, chills, flushing, nausea, vomiting, or tiredness.
	•	BeneFIX may be contraindicated in patients with a known history of hypersensitivity to hamster protein.
	•	Allergic-type hypersensitivity reactions, including anaphylaxis, have been reported for all factor IX products. Patients should be informed of the early symptoms and signs of hypersensitivity reactions. Patients should discontinue use of the product and contact their health care provider immediately and/or seek emergency care if any hypersensitivity reactions occur.

Please see BeneFIX Prescribing Information

Indication
ReFacto is indicated for the control and prevention of hemorrhagic episodes and for surgical prophylaxis and for short-term routine prophylaxis to reduce the frequency of spontaneous bleeding episodes in patients with hemophilia A. The effect of regular routine prophylaxis on long-term morbidity and mortality is unknown.

Important Safety Information

	•	As with the intravenous administration of any protein product, adverse reactions may include headache, fever, chills, flushing, nausea, vomiting, tiredness, or symptoms of allergic reactions.
	•	The remote possibility exists for hypersensitivity to non-human mammalian proteins. Known hypersensitivity to mouse or hamster proteins may be a contraindication to the use of ReFacto.
	•	Allergic reactions such as hives, itching, difficulty breathing, rapid heart rate, light-headedness and anaphylaxis have been reported for all factor VIII products. Patients should discontinue use of the product and contact their health care provider immediately and/or seek emergency care if any of these symptoms occur.

Please see ReFacto Prescribing Information

The health information contained herein is provided for educational purposes only and is not meant to replace personal discussions between health care providers and patients. All decisions about patient care must be made with a health care provider who can assess the special needs of each individual patient.