| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | ||||||
View Coupon |
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Brilinta Savings ProgramThis is a copay assistance program |
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Provided by: AstraZeneca |
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TEL: Closed Program |
Languages Spoken:
English
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Patient Assistance Applications |
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Generic Name Medications |
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Eligibility Requirements |
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| Insurance Status | May have private/commercial insurance coverage (not a participant in federal or state-funded benefits program) | |||||
| Those with Part D Eligible? | No | |||||
| Income | Not disclosed | |||||
| Diagnosis/Medical Criteria | Medically appropriate condition/diagnosis | |||||
| US Residency Required? | Must be citizen or legal resident | |||||
Application |
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| Obtaining | Anyone can enroll online | |||||
| Receiving | Not applicable | |||||
| Returning | Not applicable | |||||
| Doctor's Action | Give prescription to patient | |||||
| Applicant's Action | Print copay card from program website, bring to pharmacy with prescription to receive savings | |||||
| Decision Communicated | Not applicable | |||||
| Decision Timeframe | Not applicable | |||||
Medication |
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| Amount/Supply | Not applicable | |||||
| Sent To | Not applicable | |||||
| Delivery Time | Not applicable | |||||
| Refill Process | Patient contacts pharmacy | |||||
| Limit | Maximum of 12 times in one year | |||||
| Re-application | Request a new card after one year | |||||
Additional Information |
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| Closed Program Eligible patients can save up to $75 a month for up to 12 months on their Brilinta copay costs. |
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| Updated September 09, 2014 | ||||||
