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

FAX: 800-961-8323
Languages Spoken:

English, Spanish

Program Website


Patient Assistance Applications

AZ&Me Prescription Savings Program Application


Brand Name Medications Covered

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

Generic Name

  • aclidinium bromide powder; inhalation
  • gefitinib
  • anastrozole tablet
  • 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 tablet
  • durvalumab
  • palivizumab
  • exenatide pen
  • pramlintide acetate injection; subcutaneous
  • exenatide synthetic
  • roflumilast tablet
  • exenatide synthetic vial; subcutaneous; extended release
  • saxagliptin tablet
  • fulvestrant injection
  • ticagrelor tablet

Eligibility Requirements   

Insurance Status Must have no prescription coverage
Those with Part D Eligible? No
Income Varies. *See below for details
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 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.

At or below $35,000 for an individual, $48,000 for a couple, $60,000 for three, $70,000 for four.
Income for Faslodex, Iressa, Lynparza, and Synagis may be up to $100,000 per year regardless of household size.

Eligibility determined on a case-by-case basis.

Updated November 07, 2017