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 10/15/2018 there are 616 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.
Ranexa Connect Patient Assistance Program Enrollment Form 07/12/18
Rasuvo Disposal Program: Contact program
Rayaldee Patient Assistance Program Application (PAP) 09/19/18
Rayaldee Patient Assistance Program Application (PAP) Spanish 09/19/18
Rayaldee Service Request Form (SRF) 09/13/18
Recordati Reimbursement Hotline: Contact program
Reimbursement Support Form and Prescription for Qutenza 01/09/18
RELiZORB Patient Enrollment Form 07/03/18
Repatha Free Needle-Disposal Container Program: Contact program
Rigel OneCare Tavalisse Brochure 09/11/18
Rigel OneCare Tavalisse Enrollment Form 06/14/18
Romark Laboratories Patient Assistance Program for Alinia Enrollment Form: Contact program
Rubraca Connections Patient Brochure 02/28/18
Rubraca Connections Prescription Form 10/08/18
Ruconest Solutions Patient Brochure 05/01/18
Ruconest Solutions Patient Brochure Spanish
Ruconest Solutions Patient Enrollment Form 05/01/18
Ruconest Solutions Patient Enrollment Form (Spanish) 05/01/18
Rx Outreach Application 09/07/18
Rx Outreach Diabetic Supplies Order Form (Prodigy) 02/06/18
Rx Outreach Medication List 09/07/18
Rx Outreach Refills and New Prescription Form 02/06/18