Contact info
- Phone
- 1-833-746-6321
- Fax
- 1-888-817-2098
Eligibility
- Eligibility is determined on a case-by-case basis.
- Co-pay assistance, reimbursement support, and patient assistance programs are available for eligible patients.
- Income limit, single
- Not published
- Income limit, couple
- Not published
- Medical expenses can be deducted
- Not published
- Social Security number asked for
- Not published
- US citizenship or residency required
- Yes
Not sure where your income falls? See this year's federal poverty guidelines (opens in a new tab).
Application process
- Documents to attach
- Not published
- Prescriber license number
- NPI number
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Not published
Getting the medication
- Patient receives
- Medication
- Shipped to
- Patient
- Supply per shipment
- Not published
- Time to first delivery
- Not published
- Refills
- Not published
- Staying enrolled
- New application every 12 months
Medications covered
- Prolastin C (alpha1-proteinase inhibitor (human))