Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 2.
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AZ&Me Prescription Savings Program for people without insurance

This program provides brand name medications at no or low cost

Provided by: AstraZeneca Pharmaceuticals

1 Medimmune Way
Gaithersburg, MD 20878

TEL: 800-292-6363


Languages Spoken:

English, Spanish

Program Website

 

Program Applications and Forms

AZ&Me Prescription Savings Program Application: Contact program

 

Medications

  • anifrolumab-fnia injection; iv (Saphnelo) Injection; IV
 

Eligibility Requirements   

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

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

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

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.

Updated September 06, 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 D

This program only helps people enrolled in Medicare Part D

Provided by: AstraZeneca Pharmaceuticals

1 Medimmune Way
Gaithersburg, MD 20878

TEL: 800-292-6363


Languages Spoken:

English, Spanish

Program Website

 

Program Applications and Forms

AZ&Me Prescription Savings Program with Med D Application: Contact program

 

Medications

  • anifrolumab-fnia injection; iv (Saphnelo) Injection; IV
 

Eligibility Requirements   

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 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

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

Eligibility determined on a case-by-case basis.

*Patient must participate in Medicare Part B, Medicare Part D or Medicare Advantage

Updated September 06, 2022