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Grifols Assurance for Patients (GAP Program for IVIG)
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Grifols PatientCare Program
PO Box 3745
Alhambra, CA 91803
Phone
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(888)325-8579
Ext opt.3
Fax:
(323)441-7166
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Eligibility
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Must have a temporary lapse in insurance coverage. Must also have been treated with Grifols products for 3 continuous months prior to a lapse in coverage through a non-state or federal health insurance plan. Medicare PartD eligibility not specified. Income requirements for this program have not been disclosed. Must be citizen or legal resident. |
| Who Can Apply
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Call to have application faxed, mailed or downloaded from website. Return application via fax or mail. Doctor notified of decision within 5-7 business days. |
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Required
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Primary Immune Deficiency diagnosis required. Doctor must complete and sign the application and attach a letter of medical necessity. Patient must complete application, sign and attach insurance information. |
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Supply
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Amount/supply varies. Doctor's office must contact the company. Refill limit not specified. 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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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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| Flebogamma DIF |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form Grifols Assurance for Patients (GAP Program for IVIG) |
(Requires Acrobat Reader) 
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