Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
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Grifols Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Grifols Biologicals Inc.

Grifols-Factors for Health
PO Box 220663
Charlotte, NC 28222-0663

TEL: 844-693-2286


FAX: 888-324-1821
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Grifols Patient Assistance Program: Contact program

 

Medications

  • AlphaNine SD (coagulation factor IX (human))
 

Eligibility Requirements   

Insurance Status Must be uninsured or have a temporary lapse in insurance coverage.
Those with Part D Eligible? No
Income At or below 400% of FPL
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must reside in the US, be under the direct care of a licensed US physician and receive US health care services
   

Application

Obtaining Call
Receiving Faxed or mailed
Returning Fax or mail
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Call to enroll
Decision Communicated Doctor notified
Decision Timeframe 5-7 business days
   

Medication

Amount/Supply Up to 30 day supply
Sent To Doctor's office, hospital, or pharmacy
Delivery Time 1-3 business days
Refill Process Doctor's office must contact the company
Limit Maximum of 100,000 IU for a 12 month supply
Re-application New application every 12 months
   

Additional Information

This program also provides copay assistance.


Updated December 21, 2017


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 2.
 

Grifols Free Trial Offer

Provided by: Grifols Biologicals Inc.


TEL: 844-693-2286


Languages Spoken:

English

Program Website

 

Program Applications and Forms

Grifols Free Trial Offer: Contact program

 

Medications

  • AlphaNine SD (coagulation factor IX (human))
 

Eligibility Requirements   

Insurance Status Must be commercially insured
Those with Part D Eligible? No
Income Not Required
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must reside in the US, be under the direct care of a licensed US physician and receive US health care services
   

Application

Obtaining The Doctor should call for an application or download it from the website
Receiving Sent to Doctor's office
Returning Fax from Doctor's office
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Inform Doctor that he/she is in need
Decision Communicated Doctor notified
Decision Timeframe Not specified
   

Medication

Amount/Supply Up to 3 doses
Sent To Doctor's office or pharmacy
Delivery Time Within 2 business days
Refill Process No Refills
Limit Maximum of 12,000 IU
Re-application This is a one time program
   

Additional Information

Resources for HEALTHCARE PROFESSIONALS ONLY.

Free Trial Program: Contact Program for details


Updated December 21, 2017