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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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

  • antihemophilic factor human (Alphanate) 
 

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 February 08, 2018


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

  • antihemophilic factor (human) vial; single-use (Monoclate-P) Vial; Single-Use
 

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.
 

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

  • antihemophilic factor human (Alphanate) 
 

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 February 08, 2018