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 03/19/2018 there are 593 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.
Rasuvo Disposal Program: Contact program
Rayaldee Patient Assistance Program Application (PAP) 01/03/18
Rayaldee Patient Assistance Program Application (PAP) Spanish 01/03/18
Rayaldee Service Request Form (SRF)
REACH Program Enrollment Form 02/05/18
Recordati Reimbursement Hotline: Contact program
Reimbursement Support Form and Prescription for Qutenza 01/09/18
RELiZORB Letter of Medical Necessity (Sample Letter)
RELiZORB Patient Enrollment Form
Repatha Free Needle-Disposal Container Program: Contact program
Romark Laboratories Patient Assistance Program for Alinia Enrollment Form: Contact program
Rubraca Connections Patient Brochure 02/28/18
Rubraca Connections Prescription Form
Ruconest Solutions Patient Brochure 01/29/18
Ruconest Solutions Patient Enrollment Form 01/29/18
Ruconest Solutions Patient Enrollment Form (Spanish)
Rx Outreach Application 02/06/18
Rx Outreach Diabetic Supplies Order Form (Prodigy) 02/06/18
Rx Outreach Medication List 02/06/18
Rx Outreach Refills and New Prescription Form 02/06/18