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

This is a copay assistance program

Provided by: AstraZeneca


TEL: Closed Program


Languages Spoken:

English

 

Patient Assistance Applications

 

Generic Name Medications

 
 

Eligibility Requirements   

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

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

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

Closed Program

Eligible patients can save up to $75 a month for up to 12 months on their Brilinta copay costs.
Updated September 09, 2014