| 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. |
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Brilinta |
View Coupon |
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AZ&Me Prescription Savings Program for people without insuranceThis program provides brand name medications at no or low cost |
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Provided by: AstraZeneca Pharmaceuticals |
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1 Medimmune Way TEL: 800-292-6363 |
Languages Spoken:
English, Spanish |
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Program Applications and Forms |
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AZ&Me Prescription Savings Program: Contact program |
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AZ&Me Prescription Savings Program: Contact program (Spanish) |
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Medications |
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Eligibility Requirements |
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| Insurance Status | Must have no prescription coverage for needed medication | ||
| Those with Part D Eligible? | No | ||
| Income | Varies | ||
| Diagnosis/Medical Criteria | Not required | ||
| US Residency Required? | Yes | ||
Application |
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| Obtaining | Call, download or apply online | ||
| Receiving | Complete online, download from website or faxed. | ||
| Returning | Fax, mail or submit online | ||
| Doctor's Action | Give prescription to patient or Fax in prescription | ||
| Applicant's Action | Complete section, sign, attach required documents | ||
| Decision Communicated | Patient and Doctor are notified | ||
| Decision Timeframe | Within 2 weeks | ||
Medication |
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| 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 | Contact program for details. | ||
| Limit | None | ||
| Re-application | Varies | ||
Additional Information |
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| 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. |
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| Updated May 02, 2023 | |||
| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 2 of 2. | |||
Brilinta |
View Coupon |
||
AZ&Me Prescription Savings Program for people with Medicare Part DThis program only helps people enrolled in Medicare Part D |
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Provided by: AstraZeneca Pharmaceuticals |
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1 Medimmune Way TEL: 800-292-6363 |
Languages Spoken:
English, Spanish |
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Program Applications and Forms |
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AZ&Me Prescription Savings Program with Med D: Contact program |
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AZ&Me Prescription Savings Program with Med D: Contact program (Spanish) |
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Medications |
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|
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Eligibility Requirements |
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| Insurance Status | Contact program for details. | ||
| Those with Part D Eligible? | Required | ||
| Income | Varies | ||
| Diagnosis/Medical Criteria | Not required | ||
| US Residency Required? | Yes | ||
Application |
|||
| Obtaining | Call, download or apply online | ||
| Receiving | Complete online, download from website or faxed. | ||
| Returning | Fax, mail or submit online | ||
| Doctor's Action | Give prescription to patient or Fax in prescription | ||
| Applicant's Action | Complete section, sign, attach required documents | ||
| Decision Communicated | Patient and Doctor are notified | ||
| Decision Timeframe | Within 2 weeks | ||
Medication |
|||
| 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 | Contact program for details. | ||
| Limit | None | ||
| Re-application | Must re-enroll at end of calendar year | ||
Additional Information |
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| Eligibility determined on a case-by-case basis. *Patient must participate in Medicare Part B, Medicare Part D or Medicare Advantage This program may provide a Bridge Program for eligible patients who experience a delay, temporary loss, or change in coverage. Contact program for details. |
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| Updated May 02, 2023 | |||
