Prescription Assistance Program

DO YOU QUALIFY?
In order to qualify for this service, you must meet all of the following requirements:

• US Resident
• Do not have prescription coverage
• Do not have Medicare
• Do not have Medicaid
• Have household income at or below 200% of the Federal Poverty Level

ENROLLMENT PROCEDURE OVERVIEW

• Your health provider will request that your medications be ordered through the medication program.
• You must complete an application and sign it. You will be required to provide certain information, such as proof of income. The requirements vary from company to company. If your application is approved, each medication that is available will be ordered for you through the medication program.
• When you return the completed application and all required documents to the medication program, a physician will review it, and approve and sign it.
• After the doctor has approved and signed the application, it is sent to the pharmaceutical company for their review.
• If you are approved for the medication program, it will take approximately 8 weeks from the date of approval for your medication to arrive. You will be notified by postcard that your medication has arrived. It will include instructions for picking up your medications.
• You must renew your application every three months.

We try our best to secure medications on your behalf; however, each pharmaceutical company has its own policies and financial guidelines, which we must follow.