Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  

Patient Access Network Foundation (PAN)

This is a copay assistance program

Provided by: Patient Access Network Foundation

TEL: 866-316-7263

FAX: 866-316-7261
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website


Program Applications and Forms

Patient Access Network Foundation (PAN) Application: Contact program



  • azilsartan medoxomil tablet (Edarbi) Tablet

Eligibility Requirements   

Insurance Status *See Additional Information section below
Those with Part D Eligible? Determined case by case
Income Between 400-500% of FPL
Diagnosis/Medical Criteria FDA Approved Diagnosis - See Program Website for Details
US Residency Required? Must reside and receive treatment in US


Obtaining Call or complete online
Receiving Complete online or by phone
Returning Not applicable
Doctor's Action Varies
Applicant's Action Call for information or inform doctor that he/she is in need
Decision Communicated Patient and Doctor are notified
Decision Timeframe Within 48 hours


Amount/Supply Not applicable
Sent To Patient is sent savings card to be used at pharmacy
Delivery Time Once approved; shipped same day
Refill Process Patient presents voucher/card to pharmacy for each refill
Limit None
Re-application New application every 12 months

Additional Information

*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance.

Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly.

Note: All new enrollment is now done electronically or over the phone. Contact program for details.

Updated February 21, 2024