Enroll in HemAssist
It takes just a few steps
You can either enroll online OR fill out an enrollment form with your healthcare provider.
Fax your enrollment form
Select your treatment, download, and bring this enrollment form to your HCP office. They can complete it and fax it to HemAssist at 1-855-398-7634.
ALPROLIX® [Coagulation Factor IX (Recombinant), Fc Fusion Protein] Enrollment Form
ALTUVIIIO® [antihemophilic factor (recombinant), Fc‑VWF‑XTEN fusion protein‑ehtl] Enrollment Form
CABLIVI® (caplacizumab-yhdp) Enrollment Form
ELOCTATE® [Antihemophilic Factor (Recombinant), Fc Fusion Protein] Enrollment Form
Qfitlia™ (fitusiran) Enrollment Form
- Please see full Prescribing Information, including SERIOUS SIDE EFFECTS, and Medication Guide.
What happens next
After you enroll, we'll help you get started right away.
Answer the welcome call
The HemAssist team will reach out to help onboard you to the program.
Understand your costs
A HemAssist team member will verify your insurance coverage and assess which financial assistance programs you may be eligible for.
Get ongoing support
The HemAssist team will be in touch about medication delivery and will introduce you to the other members of your team who can help with treatment support.
