Programas de asistencia al paciente para Alphanine Sd

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Si califica, los programas a continuación le pueden ser útiles para conseguir AlphaNine SD. Revise la información para saber si califica. Las solicitudes están disponibles en formato PDF y deben enviarse directamente a quien proporciona el programa de asistencia al paciente.

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Grifols Patient Assistance Program

(Programa 1 de 3 — Para visualizar todos, deberá desplazarse hacia abajo )

Provienen de: Grifols Biologicals, Inc.
Grifols-Factors for Health PO Box 220663 Charlotte, NC 28222
TEL: 844-693-2286
FAX: 888-324-1821
Idiomas hablados:
English, Spanish, Others By Translation Service
La Página del Programa
Medicamentos
  • AlphaNine SD (coagulation factor IX (human))
Requisitos de Elegibilidad
  • Insurance Status Must be uninsured or have a temporary lapse in insurance coverage.
  • Those with Part D Elibible? No
  • Income At or below 400% of FPL
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? Patient must reside in the US, be under the direct care of a licensed US physician and receive health care services via the US health care system.
Solicitud
  • Obtaining Call
  • Receiving Faxed or mailed
  • Returning The completed application can be faxed or mailed back.
  • 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
Medicamento
  • Amount/Supply Up to 30 day supply
  • Sent To Doctor's office, hospital, or pharmacy
  • Delivery Time 1-3 business days
  • Refill Proces 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
Información Adicional
This program also provides copay assistance.
Actualizado November 7, 2018

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Patient Access Network Foundation (PAN)

(Programa 2 de 3 — Para visualizar todos, deberá desplazarse hacia abajo )

Provienen de: Patient Access Network Foundation
None
TEL: 866-316-7263
FAX: 866-316-7261
Idiomas hablados:
English, Spanish, Others By Translation Service
La Página del Programa
Medicamentos
  • AlphaNine SD (coagulation factor IX (human))
Requisitos de Elegibilidad
  • Insurance Status *See Additional Information section below
  • Those with Part D Elibible? Determined case by case
  • Income Between 400-500% of FPL
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? Must reside and receive treatment in US
Solicitud
  • Obtaining Call or complete online
  • Receiving Complete online or by phone
  • Returning Complete online or by phone
  • Doctor's Action Will be discussed with patient and Doctor after request is received
  • Applicant's Action Call for information or inform doctor that he/she is in need
  • Decision Communicated Patient and Doctor notified in writing
  • Decision Timeframe Within 48 hours
Medicamento
  • Amount/Supply Not applicable
  • Sent To Patient sent card to be used at pharmacy
  • Delivery Time Once approved; shipped same day
  • Refill Proces Patient presents voucher/card to pharmacy for each refill
  • Limit None
  • Re-application New application every 12 months
Información Adicional
*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance. Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly. Note: All new enrollment is now done electronically or over the phone. Contact program for details.
Actualizado July 10, 2018

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Grifols Free Trial Offer

(Programa 3 de 3 — Para visualizar todos, deberá desplazarse hacia abajo )

Provienen de: Grifols Biologicals, Inc.
None
TEL: 844-693-2286
Idiomas hablados:
English
La Página del Programa
Solicitudes y Formularios
Medicamentos
  • AlphaNine SD (coagulation factor IX (human))
Requisitos de Elegibilidad
  • Insurance Status Must be commercially insured
  • Those with Part D Elibible? No
  • Income Not Required
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? Patient must reside in the US, be under the direct care of a licensed US physician and receive health care services via the US health care system.
Solicitud
  • Obtaining The Doctor should call for an application or download it from the website
  • Receiving Sent to Doctor's office
  • Returning The completed application should be faxed back from the 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
Medicamento
  • Amount/Supply Up to 3 doses
  • Sent To Doctor's office or pharmacy
  • Delivery Time Within 2 business days
  • Refill Proces No Refills
  • Limit Maximum of 12,000 IU
  • Re-application This is a one time program
Información Adicional
Resources for HEALTHCARE PROFESSIONALS ONLY. Free Trial Program: Contact Program for details
Actualizado June 20, 2018

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