Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 3.
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AATmosphere iNSPIRATION Alpha-1 Program

This program provides brand name medications at no or low cost

Provided by: Shire Pharmaceuticals

AATmosphere
PO Box 231990
Centreville, VA 20120-1990

TEL: 866-272-5278


Languages Spoken:

English

Program Website

 

Program Applications and Forms

AATmosphere iNSPIRATION Alpha-1 Program: Contact program

 

Medications

  • alpha1-proteinase inhibitor (human) injection (Aralast NP) Injection
 

Eligibility Requirements   

Insurance Status Must be uninsured
Those with Part D Eligible? Not specified
Income Not disclosed
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must be US citizen or permanent resident
   

Application

Obtaining Call
Receiving Faxed
Returning Fax
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Call for information or inform doctor that he/she is in need
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply Not specified
Sent To Not specified
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
Re-application Not specified
   

Additional Information


Updated August 14, 2017


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 3.
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CSL Behring Care Coordination Center

Provided by: CSL Behring

PO Box 615011020
First Avenue
King of Prussia, PA 19406-0901

TEL: 800-676-4266


Languages Spoken:

English

Program Website

 

Program Applications and Forms

CSL Behring Care Coordination Center:Contact program

 

Medications

  • alpha1-proteinase inhibitor (human) vial (Zemaira) Vial
 

Eligibility Requirements   

Insurance Status Determined case by case
Those with Part D Eligible? No
Income Not disclosed
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must be citizen or legal resident
   

Application

Obtaining Call. *See Additional Information section below
Receiving Faxed or mailed
Returning Fax
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Decision made during phone screening
Decision Timeframe Not specified
   

Medication

Amount/Supply Varies
Sent To Varies
Delivery Time Not specified
Refill Process Not specified
Limit Varies
Re-application Varies
   

Additional Information

Since drug availability changes based on inventory, call to make sure requested drug is available.

This program lists medications that may be covered under a different CSL Behring savings program: Contact Program for more details
*877-355-4447: Carimune, Hizentra & Privigen
*866-936-2472: Zemaira

The Berinert Copay BEnefit covers up to $12,000 in eligible out-of-pocket expenses per year.
Patient must be diagnosed with HAE (Hereditary Angleodema)

Assurance Program: Once enrolled in the Program, Patient will begin earning an Award Certificate for every 3 consecutive months of therapy use. Each Certificate is worth a 1-month supply of therapy (up to the maximum amount redeemable) and can be redeemed in the event of a lapse in insurance.


Updated July 27, 2017


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 3 of 3.
 

Prolastin Direct Program

For Healthcare Professionals Only

Provided by: Grifols

c/o Dohmen Life Science

TEL: 800-305-7881


FAX: 866-588-6940
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Prolastin Direct Prescription and Enrollment Form/SMN

 

Medications

  • alpha1-proteinase inhibitor (human) (Prolastin C) 
 

Eligibility Requirements   

Insurance Status Determined case by case
Those with Part D Eligible? Not specified
Income Not disclosed
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must reside in the US
   

Application

Obtaining Doctor/Doctor's office must call or download
Receiving Faxed or downloaded from website
Returning Fax
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Inform Doctor that he/she is in need
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply Not specified
Sent To Not specified
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
Re-application Not specified
   

Additional Information

Resources for HEALTHCARE PROFESSIONALS ONLY.

Co-payment assistance, reimbursement support, and patient assistance programs are available for eligible patients.


Updated November 01, 2017