HAP Forms

• HAP Provider Enrollment Application (PDF)
• The Hemophilia Assistance Program Fact Sheet (PDF) is a one-page overview of the program.
• To learn about covered benefits, requirements and limitations, download the HAP Allowable Product and Fee List (PDF).

Program Application for Benefits

Applications can be submitted year-round. To apply, the Client Application and the Physician Assessment Form must be completed and submitted.

• Form 3033, Hemophilia Assistance Program Application
• Form 3032, Hemophilia Assistance Program Physical Assessment