Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
 

AZ&Me Prescription Savings Program for people without insurance

This program provides brand name medications at no or low cost

Provided by: AstraZeneca Pharmaceuticals

PO Box 898
Somerville, NJ 08876

TEL: 800-292-6363


Languages Spoken:

English, Spanish

Program Website

 

Patient Assistance Applications

AZ&Me Prescription Savings Program Application

AZ&Me Prescription Savings Program Application (Synagis)

AZ&Me Prescription Savings Program Application for Specialty Care Products

 

Brand Name Medications Covered

 
  • Bevespi Aerosphere
  • Kombiglyze XR tablet; extended release
  • Brilinta tablet
  • Lynparza
  • Bydureon BCise
  • Movantik tablet
  • Bydureon Pen
  • Onglyza tablet
  • Bydureon vial; subcutaneous; extended release
  • Pulmicort Flexhaler powder; inhalation
  • Byetta pen
  • Qtern
  • Calquence
  • Symbicort aerosol; inhalation
  • Daliresp tablet
  • Symlin injection; subcutaneous
  • Farxiga tablet
  • Synagis
  • Fasenra
  • Tagrisso
  • Faslodex
  • Tudorza Pressair powder; inhalation
  • Imfinzi
  • Xigduo XR tablet; extended release
  • Iressa
 

Generic Name

 
  • acalabrutinib
  • fulvestrant
  • aclidinium bromide powder; inhalation
  • gefitinib
  • benralizumab
  • glycopyrrolate/formoterol fumarate
  • budesonide powder; inhalation
  • metformin/saxagliptin tablet; extended release
  • budesonide/formoterol fumarate dihydrate aerosol; inhalation
  • naloxegol oxalate tablet
  • dapagliflozin propanediol/metformin tablet; extended release
  • olaparib
  • dapagliflozin tablet
  • osimertinib
  • dapagliflozin/saxgliptin
  • palivizumab
  • durvalumab
  • pramlintide acetate injection; subcutaneous
  • exenatide
  • roflumilast tablet
  • exenatide pen
  • saxagliptin tablet
  • exenatide synthetic
  • ticagrelor tablet
  • exenatide synthetic vial; subcutaneous; extended release
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage
Those with Part D Eligible? No
Income Varies
Diagnosis/Medical Criteria Not specified
US Residency Required? Yes, or have green card or work visa
   

Application

Obtaining Call, download or apply online
Receiving Faxed, mailed or downloaded from website
Returning Fax from Doctor's office
Doctor's Action Give prescription to patient
Applicant's Action Complete section, sign, attach proof of income and any insurance information
Decision Communicated Patient notified in writing
Decision Timeframe Within 2 weeks
   

Medication

Amount/Supply Up to 90 day supply
Sent To Doctor's office or patient's home
Delivery Time Within 5-7 business days
Refill Process Patient or Doctor must contact company
Limit None
Re-application New application yearly
   

Additional Information

People who are in Medicare and may be eligible for the Limited Income Subsidy can apply. However, if they are accepted into the LIS, they are no longer eligible for the AZ& Me Prescription Savings Program.

Eligibility determined on a case-by-case basis.


Updated June 15, 2018