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Patient Assistance Information

 
 
 
Grifols Patient Assistance Program

Grifols-Factors for Health
PO Box 220663
Charlotte, NC 28222
Phone : (844)693-2286
Fax: (888)324-1821
Eligibility
> 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
> Call to have application faxed or mailed. Return application via fax or mail. Doctor notified of decision within 5-7 business days.
Required
> FDA-approved diagnosis required. Doctor must complete application, sign and return required documents. Patient must call to enroll.
Supply
> 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.
Ship To
> Ships to Doctor's office, hospital, or pharmacy within 1-3 business days.
Note
> This program also provides copay assistance.
 
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.
 
Alphanate injection
AlphaNine SD injection
Profilnine injection