Hyqvia Patient Assistance Programs

Hyqvia: Apply for prescription assistance below

If you are eligible, the programs below can help you afford HyQvia. Review the information to see if you qualify. The applications are available in Adobe PDF format and should be mailed directly to the provider of the patient assistance program.

If you have any questions, please call the telephone number for the program (not PharmacyChecker.com) or go to the program website.

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My IG Source Program

(Program 1 of 1 — Scroll down to see them all)

Provided by: Shire Pharmaceuticals
None
TEL: 855-250-5111
Languages Spoken:
English
Program Website
Program Applications and Forms
Medications
  • HyQvia (immune globulin; infusion (human) with (recombinant) human hyaluronidase)
Eligibility Requirements
  • Insurance Status Determined case by case
  • Those with Part D Elibible? Varies
  • Income Not disclosed
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? US residency requirements are not specified.
Application
  • Obtaining Call for prescreening or apply online
  • Receiving Varies
  • Returning The completed application must be faxed back.
  • Doctor's Action Varies
  • Applicant's Action Call for information or inform doctor that he/she is in need
  • Decision Communicated Not specified
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Not specified
  • Sent To Not specified
  • Delivery Time Not specified
  • Refill Proces Not specified
  • Limit Not specified
  • Re-application Not specified
Additional Information
Eligibility determined on a case-by-case basis.
Updated August 2, 2018

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