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

Program 1 of 6   Scroll down to see them all.  Updated May 08, 2013 Back | Print Page

This program provides brand name medications at no or low cost.

AZ&Me Prescription Savings program for people without insurance

Provided by:


AstraZeneca Pharmaceuticals
PO Box 66551
St. Louis, MO 63166-6551

TEL: 800-424-3727


ALT PHONE: 800-292-6363
FAX: 800-961-8323
 Program Website

Languages Spoken: English

Patient assistance
applications

 

Medications

Arimidex Tablet 1mg (anastrozole)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must have no prescription coverage
Those with Part D Eligible? No
Income At or below $35,000 for an individual, $48,000 for a couple, $60,000 for three, 70,000 for four
Diagnosis/Medical Criteria Not specified
US Residency Required? Yes, or have green card or work visa
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
Amount/Supply Not specified
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:

The application for this program and the AstraZeneca Cancer Support Network Patient Assistance Program is the same and says Application for Free AstraZeneca Medicines on the upper left side. 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.
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 2 of 6   Scroll down to see them all.  Updated May 23, 2013 Back | Print Page

This program provides brand name medications at no or low cost.

AstraZeneca Cancer Support Network (AZCSN)

Provided by:


AstraZeneca Pharmaceuticals
PO Box 66551
St Louis, MO 63166-6551

TEL: 866-992-9276 OPT 1


ALT PHONE:
FAX: 800-961-8323
 Program Website

Languages Spoken: English

Patient assistance
applications

 

Medications

Arimidex Tablet 1mg (anastrozole)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must have no prescription coverage
Those with Part D Eligible? Yes, if medication is not covered
Income Varies
Diagnosis/Medical Criteria Not specified
US Residency Required? Yes, or have green card or work visa
Obtaining Call, download or apply online
Receiving Not specified
Returning Mail or fax
Doctor's Action Give prescription to patient
Applicant's Action Complete section, sign, attach proof of income
Decision Communicated Patient notified of denial in writing
Decision Timeframe Not specified
Amount/Supply Up to 60 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 Not specified
Re-application Enrollment is for 12 months, reapplication available at 10 months

Additional Information:

The application for this program is called Application for Free AstraZeneca Medicines. 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. This program has expanded the eligibility for assistance for qualifying patients who have lost their jobs, prescription drug coverage, had a change in income or household size.

Income guidelines vary for residents of Alaska and Hawaii, contact the program for more information.
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 3 of 6   Scroll down to see them all.  Updated May 08, 2013 Back | Print Page

This program only helps people enrolled in Medicare Part D.

AZ&Me Prescription Savings Program for people with Medicare Part D

Provided by:


AstraZeneca Pharmaceuticals
P.O. Box 66551
St. Louis, MO
63166-6551

TEL: 800-292-6363


ALT PHONE:
FAX: 800-961-8323
 Program Website

Languages Spoken: English

Patient assistance
applications

 

Medications

Arimidex Tablet 1mg (anastrozole)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status May have Medicare Part D
Those with Part D Eligible? Required
Income At or below $35,000 for an individual, $48,000 for a couple, $60,000 for three, 70,000 for four
Diagnosis/Medical Criteria Not specified
US Residency Required? Yes, or have green card or work visa
Obtaining Call, download or apply online
Receiving Faxed, mailed or downloaded from website
Returning Mail or fax
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
Decision Timeframe Within 2 weeks
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 Must re-enroll at end of calendar year

Additional Information:

The applicant must have spent at least 3% of the annual household income on prescription drugs this year.
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 4 of 6   Scroll down to see them all.  Updated March 25, 2013 Back | Print Page

This is a copay assistance program.

Diplomat's Co-Pay Assistance Navigator Program

Provided by:


Diplomat Specialty Pharmacy
4100 S Saginaw St.
Flint, MI 48507

TEL: 877-977-9118 ext. 89864


ALT PHONE:
FAX: 810-282-0176
 Program Website

Languages Spoken: English

Patient assistance
applications


 

Medications

Arimidex Tablet 1mg (anastrozole)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Determined case by case
Those with Part D Eligible? Yes
Income Determined case by case
Diagnosis/Medical Criteria Medically appropriate condition
US Residency Required? Yes
Obtaining Call or complete online
Receiving Faxed, mailed or complete online
Returning Mail or fax
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Complete section, sign and provide annual income information. Proof of income may be request by program at any time
Decision Communicated Patient and/or Doctor are notified
Decision Timeframe Within 1-2 business days
Amount/Supply Amount requested is sent
Sent To Patient's home
Delivery Time Once approved; within 2 business days
Refill Process Company contacts patient to arrange
Limit Varies per medication
Re-application Determined case by case

Additional Information:

Diplomat Specialty Pharmacy is a full service pharmacy that can help patients seek funding assistance for the co-pay portion of their required medications. Applications can be completed online or Prescription, Demographics and Proof of Income may be faxed to 810-282-0176 Attn: Dorrie 
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 5 of 6   Scroll down to see them all.  Updated May 10, 2013 Back | Print Page

This is a copay assistance program.

HealthWell Foundation Copay Program

Provided by:


HealthWell Foundation
P.O Box 4133
Gaithersburg, MD 20897-7811

TEL: 800-675-8416


ALT PHONE:
FAX: 800-282-7692
 Program Website

Languages Spoken: English, Others By Translation Service

Patient assistance
applications

 

Medications

Arimidex Tablet 1mg (anastrozole)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status May have insurance
Those with Part D Eligible? Yes
Income Less than 400% of FPL.may qualify. Cost of living in a particular city or state is considered.
Diagnosis/Medical Criteria Medically appropriate condition
US Residency Required? Must reside in the US
Obtaining Call or complete online
Receiving Sent out or may be completed online
Returning Mail
Doctor's Action Complete section, sign
Applicant's Action Complete section, sign, attach proof of income
Decision Communicated Patient notified in writing
Decision Timeframe 3-5 business days
Amount/Supply Not applicable
Sent To
Delivery Time
Refill Process Good for one year
Limit Not specified
Re-application New application every 12 months

Additional Information:

This program provides financial assistance to eligible individuals to cover coinsurance, copayments, healthcare premiums and deductibles for certain treatments. Also, for those who are eligible for health insurance, but cannot afford the insurance premium, the foundation may be able to help by paying some or all of the medical portion of insurance premiums. The patient is being treated for a specific disease for which funding is available and has insurance that covers the treatment for this disease.

Call for most recent medications as the list is subject to change.
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 6 of 6.  Updated February 12, 2013 Back | Print Page

This is a copay assistance program.

Patient Access Network Foundation

Provided by:


Patient Access Network Foundation
PO Box 221858
Charlotte, NC 28222

TEL: 866-316-7263


ALT PHONE:
FAX: 866-316-7261
 Program Website

Languages Spoken: English, Spanish, Others By Translation Service

Patient assistance
applications


 

Medications

Arimidex Tablet 1MG (anastrozole)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must have insurance
Those with Part D Eligible? Yes
Income At or below 500% of FPL
Diagnosis/Medical Criteria Medically appropriate condition
US Residency Required? Must reside and receive treatment in US
Obtaining Call or complete online
Receiving Sent out or may be completed online
Returning Fax, mail or submit online
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Complete section, sign, attach proof of income
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe Within 48 hours
Amount/Supply Not applicable
Sent To Patient sent card to be used at pharmacy
Delivery Time Once approved ; shipped same day.
Refill Process Patient presents voucher/card to pharmacy for each refill
Limit None
Re-application New application every 12 months

Additional Information:

Call for most recent medications as the list is subject to change.



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