Prolastin C Patient Assistance Programs

Prolastin C: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Prolastin C. Review the information to see if you qualify. The applications are available in Adobe PDF format and should be mailed directly to the provider of the patient assistance program.

If you have any questions, please call the telephone number for the program (not PharmacyChecker.com) or go to the program website.

Looking for a different medication?

Prolastin Direct Program

(Program 1 of 1 — Scroll down to see them all )

Provided by: Grifols
c/o Dohmen Life Science
TEL: 800-305-7881
FAX: 866-588-6940
Languages Spoken:
English, Others By Translation Service
Program Website
Medications
  • Prolastin C (alpha1-proteinase inhibitor (human))
Eligibility Requirements
  • Insurance Status Determined case by case
  • Those with Part D Elibible? Not specified
  • Income Not disclosed
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? The patient must also be residing in the US.
Application
  • Obtaining Doctor/Doctor's office must call or download
  • Receiving Faxed or downloaded from website
  • Returning The completed application must be faxed back.
  • 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 Not specified
  • Sent To Not specified
  • Delivery Time Not specified
  • Refill Proces Not specified
  • Limit Not specified
  • Re-application Not specified
Additional Information
Resources for HEALTHCARE PROFESSIONALS ONLY. Co-payment assistance, reimbursement support, and patient assistance programs are available for eligible patients.
Updated October 19, 2018

Back to top