Privigen Infusion
Order Form

Privigen 

Privigen is intravenous immune globulin therapy used to treat patients with primary immunodeficiency (PI), chronic inflammatory demyelinating polyneuropathy, or patients 15 years of age or older with chronic immune thrombocytopenic purpura. Since the medication is derived from human plasma, there’s always a risk of virus transmission, as well as Chreutzfeldt-Jakob disease (CJD) and its variant (vCJD).

Please refer to the full prescribing information.

Note: Please speak with your healthcare provider for more information if you think this therapy might be right for you.

How do I make a referral or transition my treatment to Infusion Associates?

Customized Care

1. Ask your healthcare provider to fax us a completed order form for your medication, clinical notes, demographics and your insurance card to (833) 996-4888.

2. Providers can find order forms on our medications page.

On Staff Pharmacist

3. One of our intake specialists will contact your healthcare provider to confirm receipt of your referral.

4. We will then verify benefits, obtain any required prior authorizations, and contact you to schedule an appointment.