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

Program 1 of 2   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

Atacand HCT Tablet 16/12.5mg, 32/12.5mg, 32/25mg (candesartan cilexetil hydrochlorothiazide)

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 2.  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

Atacand HCT Tablet 16/12.5mg, 32/12.5mg, 32/25mg (candesartan cilexetil hydrochlorothiazide)

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.



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