Compassionate support
for your patients

Caring team members connect eligible patients with Financial Assistance if they qualify.

Patient Assistance Program

Covis Pharma is committed to helping patients access their FERAHEME treatment. Eligible uninsured and commercially underinsured patients may receive a single course of therapy at no cost.* To assess eligibility, complete the HCP Patient Assistance Program Form and have the patient complete the Patient Assistance Application. 

Find the Feraheme Assist patient certification and income verification form required for participation in the Patient Assistance Program

DOWNLOAD PATIENT DOCUMENTATION
DOWNLOAD PHYSICIAN ENROLLMENT FORM

Upon receipt of the Patient Assistance Program HCP Form and Patient Application:

  • You will receive a fax confirming receipt of the enrollment form(s)
  • You will receive a notification of the patient’s status in the program when all forms are received and evaluated for eligibility

Reimbursement Resource

Use this letter as a template if a health plan denies FERAHEME coverage

download a sample letter of appeal

*Each patient’s eligibility is evaluated on an individual basis. To be eligible, patients must meet the FDA-approved indication for FERAHEME. In compliance with federal regulations, patients insured by a government-funded program (Medicaid, Medicare, TRICARE, etc) are not eligible. Patient must be at or below 500% federal poverty level based on residency to participate. This program may be discontinued or modified at any time based on eligibility, state and local laws, and program availability. For full program eligibility, restrictions, and enrollment requirements, please contact Feraheme Assist.

Have questions?
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Translation services in >250 languages to help ensure language is not a barrier.
1.844.635.2624 (Monday – Friday 8am – 6pm ET).

FERAHEME has favorable non-restricted commercial coverage

According to the Hospital Outpatient Prospective Payment System (HOPPS) 2020 final fee schedule, FERAHEME was granted the status indicator “K,” which means it has its own Ambulatory Payment Classification (APC).

For more information, please visit the Centers for Medicare & Medicaid Services website at https://www.cms.gov/Medicare/Medicare.html.

PP-FRH-US-00501 10/22

Additional resources are available for you and your patients.

SEE RESOURCES