Program Applications

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Tips for using the applications:

  • You will need Adobe Reader to open the applications. Download this free program or the latest version, which is recommended.
  • Click the button in the top right of the application to turn on the Highlight Fields Option which will highlight the fields to be filled out.
  • Use the "tab" key to easily go to the next field.

As of 10/19/2018 there are 603 applications available.

Click on the first letter of the name of the program. Then click on the application for that program. Dates next to each listing reflect the last update. Some applications may need to be opened with a different viewer depending on which browser you are using. Firefox users may get a message saying "This PDF document might not be displayed correctly." Try clicking on the "Open With Different Viewer" option. If you are still unable to interactively complete the application, use a different browser.

Send the completed application to the address on the application and not to NeedyMeds.

If you cannot find an application or are having trouble printing one, contact the program or company.

Contact NeedyMeds if you find any content errors.

For link problems or other technical problems, send an email to webmaster.

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Haegarda Connect Prescription and Service Request Form 10/03/18
HealthWell Foundation Copay Program: Contact program
Helping Hands For Special Kids Program: Contact program
Helsinn Cares Patient Support Program Enrollment Form 09/12/18
Helsinn Cares Program Requirements Brochure 09/12/18
Hematology Support Center Enrollment Form: Contact program
Heplisav-B Access Navigator: Contact program
Heron Connect Insurance Verification and Program Enrollment Form 08/06/18
Heron Connect Practice Enrollment Form 08/06/18
HETLIOZ Patient Prescription Form-Veterans Only 08/16/18
HETLIOZSolutions Prescription & Service Request Form 09/06/18
HIV Common Application: AbbVie (KALETRA, NORVIR) 10/05/18
HIV Common Application: Boehringer Ingelheim Cares (APTIVUS, VIRAMUNE XR) 10/05/18
HIV Common Application: Bristol-Myers Squibb (REYATAZ, SUSTIVA) 10/05/18
HIV Common Application: Gilead Sciences 10/11/18
HIV Common Application: Johnson & Johnson Patient Assistance Foundation, Inc. 10/05/18
HIV Common Application: ViiV Healthcare 10/05/18
Horizon Cares Enrollment Form: Contact program
Hospital-to-Home Program Enrollment Form: Contact program
Humira Pen and Syringe Diposal Service: Contact company
Hyalgan Reimbursement Services and Patient Assistance Program Application 10/16/18
Hymovis Reimbursement Services and Patient Assistance Program Application 10/19/18
HyperImmune Patient Assistance Program Application 10/18/18

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