| 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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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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PO Box 222178 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 Application |
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AZ&Me Prescription Savings Program Application (Spanish) |
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AZ&Me Prescription Savings Program Application for Specialty Care Products |
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AZ&Me Prescription Savings Program Application for Specialty Care Products (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 or download | ||
| Receiving | Faxed, mailed or downloaded from website | ||
| Returning | Fax or mail | ||
| 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 | Patient or Doctor must contact company | ||
| 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 August 05, 2022 | |||
| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 2 of 2. | |||
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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PO Box 222178 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 Application |
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AZ&Me Prescription Savings Program with Med D Application (Spanish) |
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AZ&Me Prescription Savings Program with Med D Application for Specialty Care Products |
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AZ&Me Prescription Savings Program with Med D Application for Specialty Care Products (Spanish) |
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Medications |
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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 |
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| Obtaining | Call or download | ||
| Receiving | Faxed, mailed or downloaded from website | ||
| Returning | Fax or mail | ||
| 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 | Patient or Doctor must contact company | ||
| 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 |
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| Updated August 05, 2022 | |||
