ARA-ASSIST

• Considering Alpha-1 Testing
• Newly Diagnosed with Alpha-1
• Living With Alpha-1

Ara-Assist Enrollment Form

Preparing For A Doctor's Visit

Are you concerned about what would happen if you lost your insurance coverage?

By participating in the ARA-ASSIST Program, you can continue your ARALAST therapy at no charge.

The ARA-ASSIST Program is a way for eligible users of Baxter's ARALAST therapy to continue to receive their ARALAST without charge in the event of a lapse in insurance. Individuals who participate in the program and their families enjoy peace of mind knowing they can continue their therapy despite an insurance lapse.

Who is eligible?

Any user of Baxter's ARALAST who has third-party insurance, is on a state-sponsored program, or is on Medicaid or Medicare, is eligible to participate in the program.

How does the program work?

Once you're enrolled, you will receive one ARA-ASSIST Certificate of Participation for every four months you use ARALAST.

To remain active in the program, every four months you complete a utilization form to verify your continued use of ARALAST and mail it to PAREXEL, the independent program administrator for the ARA-ASSIST Program.

After one year of continuous use of ARALAST, you can redeem each certificate for a one-month supply (based on your usage) of augmentation therapy, should you have an insurance lapse.

Up to 12 certificates (representing four years of continuous use of ARALAST) can be collected. A maximum of twelve certificates can be redeemed in one calendar year.

If you remain on ARALAST therapy, your ARA-ASSIST certificates are good for five years after you receive them.

Private and Secure

To ensure the confidentiality of your personal information, the ARA-ASSIST Program is administered by PAREXEL, a company that provides special support programs and patient advocacy services for families affected by chronic or long-term health conditions. PAREXEL is the independent program administrator for the ARA-ASSIST Program.

How to Enroll

• Complete an enrollment form , and return it to PAREXEL by fax: 1-800-643-9450 or mail: PAREXEL, P.O. Box 230906, Centreville, Virginia 20120.
• Call the ARA-ASSIST Program at 1-888-229-8379 and complete the form over the phone.
• Complete the form online.

Enrollment confirmation letters will be mailed to each enrollee within two weeks of receipt of application. Your enrollment will remain as long as the administrator receives your completed utilization forms confirming continuous usage of Baxter therapeutics. These forms will be mailed to enrollee every 4 months.

If you have questions regarding your enrollment, please contact PAREXEL at 1-888-229-8379.

To learn more about the ARA-ASSIST Program, review the ARA-ASSIST Program brochure .

ARALAST [Alpha₁-Proteinase Inhibitor (Human)] is indicated for chronic augmentation therapy in patients having congenital deficiency of A₁-PI with clinically evident emphysema. ARALAST is not indicated as therapy for lung disease patients in whom congenital A₁-PI deficiency has not been established.

Please review the Important Safety Information and the Full Prescribing Information