NeedyMeds Order Form

Use this order form to request an information packet (brochure, drug discount card, information handout) from NeedyMeds. After completing contact information below, continue with order to next page to place your information request. If you want to request information for PAPTracker software, Patient Advocate Newsletter, Patient Assistance Program Update Service (PAPUS) or partnership information, do so before continuing to next page.

If this is your first order, fill out the form below. If you have previously submitted an order, search for your information.
I would like to sign up for:

Web-based software that automates the PAP application process. Check the box to request information on PAPTracker.

NeedyMeds’ free e-newsletter featuring health-related articles and valuable resources for advocates.

NeedyMeds’ free email alert service allows you to receive important PAP updates as they become available. Sign up for either daily or weekly updates.
Weekly Daily

Click on the box to be contacted about partnering with NeedyMeds. Partnerships include branded drug discount cards for your organization/community or disease information page partnerships.