Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 5.
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CSL Behring Patient Assistance Program

This program provides medication at no cost.

Provided by: CSL Behring


TEL: 800-676-4266


ALT PHONE: 844-727-2752
Languages Spoken:

English Others By Translation Service

Program Website

 

Program Applications and Forms

CSL Behring Patient Assistance Program Request Form

 

Medications

  • alpha1-proteinase inhibitor human iv (Zemaira) IV
 

Eligibility Requirements   

Insurance Status Must be uninsured or underinsured
Those with Part D Eligible? Contact program for details.
Income At or below 250% of FPL
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must reside in the US
   

Application

Obtaining Call or download
Receiving Faxed, emailed or mailed
Returning Fax
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply Contact the program for more details.
Sent To Doctor's office, hospital, or pharmacy
Delivery Time Contact Program for Details
Refill Process Contact program for details.
Limit Contact the program for details
Re-application Contact program for details.
   

Additional Information

Closed Program

Since drug availability changes based on inventory, call to make sure requested drug is available.
Updated August 11, 2021


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 5.
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OnePath Patient Assistance Program (Aralast NP, Glassia)

This program provides brand name medications at no or low cost

Provided by: Takeda Pharmaceutical


TEL: 866-888-0660


FAX: 844-755-5751
Languages Spoken:

English, Others By Translation Service

Program Website

 

Program Applications and Forms

OnePath Start Form (Aralast NP, Glassia)

 

Medications

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

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 reside in the US
   

Application

Obtaining Call for prescreening
Receiving Downloaded from website
Returning Fax from Doctor's office
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 Patient notified
Decision Timeframe Varies
   

Medication

Amount/Supply Varies
Sent To Varies
Delivery Time Varies
Refill Process Contact program for details.
Limit None
Re-application Varies
   

Additional Information

This program provides copay assistance. Education and support services are available; Contact program for details.

Updated October 05, 2021


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 3 of 5.
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Prolastin Direct Program

This program provides brand name medications at no or low cost

Provided by: Grifols

c/o Eversana

TEL: 800-305-7881


FAX: 866-588-6940
Languages Spoken:

English, Others By Translation Service

Program Website

 

Program Applications and Forms

Prolastin Direct Prescription and Enrollment Form/SMN

Prolastin Direct Program Brochure

 

Medications

  • alpha1-proteinase inhibitor human solution; iv (Prolastin-C) Solution; IV
 

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 be a US resident and treated by a US licensed healthcare provider
   

Application

Obtaining Call, download or apply online
Receiving Complete online, download from website or faxed.
Returning Fax or submit online
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Call or enroll online
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

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

Additional Information

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

Updated September 06, 2021


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 4 of 5.
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Zemaira Connect (CareZ)

This program provides brand name medications at no or low cost

Provided by: CSL Behring


TEL: 866-936-2472


ALT PHONE: 844-727-2752
FAX: 855-829-5365
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Zemaira Connect Request Form

 

Medications

  • alpha1-proteinase inhibitor human iv (Zemaira) IV
 

Eligibility Requirements   

Insurance Status Determined case by case
Those with Part D Eligible? Contact program for details.
Income Based on FPL
Diagnosis/Medical Criteria Medically Necessary as determined by a Doctor
US Residency Required? Must be residing in the US or US territory
   

Application

Obtaining Call or download
Receiving Faxed, emailed, mailed or downloaded
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 Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply Varies
Sent To Varies
Delivery Time Contact Program for Details
Refill Process Contact program for details.
Limit Contact the program for details
Re-application Contact program for details.
   

Additional Information

Call for most recent medications as the list is subject to change: 1-844-727-2752

Updated August 11, 2021


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 5 of 5.
 

CSL Behring Assurance Program

Provided by: CSL Behring


TEL: 866-415-2164


Languages Spoken:

English

Program Website

 

Program Applications and Forms

CSL Behring Assurance Program Information

 

Medications

  • alpha1-proteinase inhibitor human iv (Zemaira) IV
 

Eligibility Requirements   

Insurance Status Must have insurance
Those with Part D Eligible? No
Income Not disclosed
Diagnosis/Medical Criteria Patient currently using a CSL Behring Therapy
US Residency Required? Must be citizen or legal resident
   

Application

Obtaining Call
Receiving Not specified
Returning Not specified
Doctor's Action Not specified
Applicant's Action Call
Decision Communicated Patient notified
Decision Timeframe Not specified
   

Medication

Amount/Supply Not applicable
Sent To Not applicable
Delivery Time Not applicable
Refill Process Not applicable
Limit Up to one year
Re-application Not applicable
   

Additional Information

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 August 25, 2021