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

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

 

Patient Assistance Applications

AZ&Me Prescription Savings Program: Contact program

AZ&Me Prescription Savings Program: Contact program (Spanish)
 

Brand Name Medications
 
  • Bevespi Aerosphere aerosol; inhalation
  • Imfinzi injection; iv
  • Breztri Aerosphere inhalation aerosol; metered
  • Imjudo injection; iv
  • Brilinta tablet
  • Lokelma oral suspension
  • Bydureon BCise extended-release injectable suspension
  • Lynparza tablet
  • Calquence tablet; film coated
  • Saphnelo injection; iv
  • Farxiga tablet
  • Symlin injection; subcutaneous
  • Fasenra injection; subcutaneous
  • Tagrisso tablet
  • Fasenra Pen injection; subcutaneous
  • Xigduo XR tablet; extended release
 

Generic Name Medications
 
  • acalabrutinib tablet; film coated
  • glycopyrrolate/formoterol fumarate aerosol; inhalation
  • anifrolumab-fnia injection; iv
  • olaparib tablet
  • benralizumab injection; subcutaneous
  • osimertinib tablet
  • budesonide-formoterol fumarate-glycopyrrolate inhalation aerosol; metered
  • pramlintide acetate injection; subcutaneous
  • dapagliflozin tablet
  • sodium zirconium cyclosilicate oral suspension
  • dapagliflozin-metformin tablet; extended release
  • ticagrelor tablet
  • durvalumab injection; iv
  • tremelimumab-actl injection; iv
  • exenatide extended-release injectable suspension
 

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, download or apply online
Receiving Complete online, download from website or faxed.
Returning Fax, mail or submit online
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 August 01, 2023