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Grifols Patient Assistance Program
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Grifols-Factors for Health
PO Box 220663
Charlotte, NC 28222
Phone
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(844)693-2286
Fax:
(888)324-1821
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Eligibility
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Must be uninsured or have a temporary lapse in insurance coverage. Medicare Part D patients are not eligible for this program. Income must be at or below 400% of FPL. Must reside in the US, be under the direct care of a licensed US physician and receive US health care services. |
| Who Can Apply
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Call to have application faxed or mailed. Return application via fax or mail. Doctor notified of decision within 5-7 business days. |
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Required
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FDA-approved diagnosis required. Doctor must complete application, sign and return required documents. Patient must call to enroll. |
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Supply
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Up to 30 day supply. Doctor's office must contact the company fro refills. Maximum of 100,000 IU for a 12 month supply. New application must be completed every 12 months. |
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Ship To
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Ships to Doctor's office, hospital, or pharmacy within 1-3 business days. |
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Note
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This program also provides copay assistance. |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| Profilnine injection |
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