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Patients enrolled in Prolastin Direct experienced 10% fewer exacerbations.1Exacerbation Reduction Graph

Prolastin Direct Alpha-1 health management program helps improve patient outcomes.

  • Total exacerbation rate decreased (P<0.001)
  • Unscheduled physician visits decreased (P=0.03)
  • Emergency room visits decreased (P=0.02)

Learn more about Alpha-1 Disease Management and Prevention Program (ADMAPP).

PROLASTIN DIRECT is the only place to order
PROLASTIN-C

Enrollment is easy:

To start a patient on PROLASTIN-C, here’s all you need to do:

  1. Fill out the secure online prescription and enrollment form
  2. Print & sign the completed forms
  3. Fax the forms along with associated medical documentation to Prolastin Direct® at 1-866-588-6940

Prolastin Direct® handles the rest on your behalf. Our staff will:

  1. Send a confirmation within 24 hours of receipt of enrollment materials
    Note: If medical information is missing, staff will contact you to gather additional information needed by the insurance company. Be sure to fax in all the requested medical documentation to avoid any delays.
  2. Coordinate insurance authorization and billing on behalf of the patient.
    If needed, PROLASTIN DIRECT staff will help patients with payment assistance program coordination.
  3. Coordinate infusion services and ship product for your patient to any location- at a clinic, at home or even on vacation
  4. Assign an AlphaNet coordinator, who will initiate health management services for your patient which help improve patient outcomes.

Before you begin

You will need 15 minutes and:

  • For all patients:
  • Prescription information for PROLASTIN-C
  • For new patients:
  • Patient’s medical results that are required by insurance to authorize AAT augmentation therapy. See medical documentation checklist of requested information
  • Patient’s payer/insurance information
  • Adobe’s free PDF Reader installed on your computer. If needed, Get Adobe PDF Reader

Get started now

You will be prompted for information to generate a prescription form (for all patients) and an enrollment form (new patients only). Then click Print. This will generate a PDF form, which you must print, sign and fax to 1-866-588-6940.

Start On-Line Prolastin-C Prescription Form

For blank forms, download here: Blank PROLASTIN-C Prescription & Enrollment Form

All online entry of information is secure. No prescription or enrollment information entered online is stored or shared—it is only used to generate the forms for you to fax to Prolastin Direct® Patient Services pharmacy.

Important Safety Information

PROLASTIN-C, Alpha1-Proteinase Inhibitor (Human) is indicated for chronic augmentation and maintenance therapy in adults with emphysema due to deficiency of alpha1-proteinase inhibitor (alpha1-antitrypsin deficiency). The effect of augmentation therapy with any alpha1-proteinase inhibitor (alpha1-PI) on pulmonary exacerbations and on the progression of emphysema in alpha1-antitrypsin deficiency has not been demonstrated in randomized, controlled clinical trials. PROLASTIN-C is not indicated as therapy for lung disease in patients in whom severe Alpha1-PI deficiency has not been established.

PROLASTIN-C may contain trace amounts of IgA. Patients with known antibodies to IgA, which can be present in patients with selective or severe IgA deficiency, have a greater risk of developing potentially severe hypersensitivity and anaphylactic reactions. PROLASTIN-C is contraindicated in patients with antibodies against IgA.

The most common drug related adverse reactions during clinical trials in ≥ 1% of subjects were chills, malaise, headache, rash, hot flush, and pruritus.

PROLASTIN-C is made from human plasma. Products made from human plasma may carry a risk of transmitting infectious agents, e.g., viruses, and, theoretically, the Creutzfeldt-Jakob disease (CJD) agent.

Please see accompanying PROLASTIN-C Full Prescribing Information for complete prescribing details.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

References
  1. Campos MA, Alazemi S, Zhang G, Wanner A, Sandhaus RA. Effects of a disease management program in individuals with alpha-1 antitrypsin deficiency. COPD. 2009;6(1):31-40.