Program Applications

Tips for using the applications:

  • You will need Adobe Reader to open the applications. Download this free program or the latest version, which is recommended.
  • Click the button in the top right of the application to turn on the Highlight Fields Option which will highlight the fields to be filled out.
  • Use the "tab" key to easily go to the next field.

As of 06/23/2017 there are 644 applications available.

Click on the first letter of the name of the program. Then click on the application for that program. Dates next to each listing reflect the last update. Some applications may need to be opened with a different viewer depending on which browser you are using. Firefox users may get a message saying "This PDF document might not be displayed correctly." Try clicking on the "Open With Different Viewer" option. If you are still unable to interactively complete the application, use a different browser.

Send the completed application to the address on the application and not to NeedyMeds.

If you cannot find an application or are having trouble printing one, contact the program or company.

Contact NeedyMeds if you find any content errors.

For link problems or other technical problems, send an email to webmaster.

A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z 

AbbVie Patient Assistance Foundation Application 04/05/17
AbbVie Patient Assistance Foundation Application for Androgel 04/05/17
AbbVie Patient Assistance Foundation Application for Creon 04/05/17
AbbVie Patient Assistance Foundation Application for HUMIRA 04/12/17
AbbVie Patient Assistance Foundation Application for Lupron Depot 04/05/17
AbbVie Patient Assistance Foundation Application for Marinol 04/12/17
AbbVie Patient Assistance Foundation Application for Norvir and Kaletra 04/05/17
AbbVie Patient Assistance Foundation for Technivie: Contact program
AbbVie Patient Assistance Foundation for Viekira XR Application 04/05/17
Access 360 Enrollment Form (Oncology) 05/03/17
Access 360 Patient Authorization Form (PAF) Oncology 05/03/17
Access 360 Patient Authorization Form (PAF) Oncology (Spanish) 05/03/17
AccessPlus Financial Assistance Brochure 03/21/17
AccessPlus Patient Assistance Program Enrollment Form 03/22/17
AccessPlus Patient Guide 03/21/17
Accredo Patient Assistance Program for Carbaglu: Contact program
Actelion Pathways Enrollment Form: Contact program
Acthar Support & Access Program (A.S.A.P): Contact program
Addyi REMS Medication Guide 01/20/17
Addyi REMS Patient-Provider Agreement Form 01/20/17
Addyi REMS Prescriber Enrollment Form 01/20/17
Akorn Patient Assistance Program Application: Contact program
Akrimax Patient Assistance Program Enrollment Form 03/23/17
Alexion Access Foundation: Contact program
Allergan Patient Assistance Program Application: Eye and Dermatology Medications 04/07/17
Allergan Patient Assistance Program Application: Medications/Devices 04/07/17
Alpha-1 AATmosphere Program: Contact program
American Regent Patient Assistance Program Application 03/22/17
American Regent Patient Assistance Program Request Form 03/22/17
American Regent Reimbursement Brochure 03/22/17
Amgen FIRST STEP Co-Pay Support: Contact program
Amgen Safety Net Foundation: Contact program
Ampyra Patient Support Services Center: Not Accepting New Enrollment
Angiomax Reimbursement and Patient Financial Assistance Program Application 03/20/17
Aptevo Therapeutics Reimbursement and Patient Assistance Program Application
Arbor Gliadel Wafer Patient Assistance Program Application 04/28/17
Arbor Patient Assistance Program Application 06/22/17
ARCH Patient Assistance Program Application Form 05/18/17
ARCH Patient Assistance Program Application Form (Spanish) 05/18/17
Arestin Rx Access Patient Eligibility Form 05/02/17
Arestin Rx Access Perscription Form 05/02/17
Aristada Care Support Copay Assistance Enrollment Form 06/06/17
Aristada Care Support Patient Assistance Program Enrollment Form 06/06/17
ASSIST Program: Contact program
Astellas Pharma Support Solutions (XTANDI) Patient Enrollment Form 05/15/17
Astellas Pharma Support Solutions Enrollment Form (CRESEMBA) 05/10/17
Astellas Pharma Support Solutions: Contact program
Astellas Stock Replacement Program: Contact program
Avanir Brochure for Nuedexta 06/01/17
Avanir Brochure for Onzetra Xsail 06/01/17
Avanir Patient Services (APS) Enrollment Form 06/01/17
AZ&Me Prescription Savings Program Application 06/02/17
AZ&Me Prescription Savings Program with Med D Application 06/02/17

Return to Top