Things to know before you begin
We consider many factors when reviewing an application. Examples include:
- Your family size
- The medication you are taking
- Insurance status
- Financial hardship
- Other special circumstances
Even if you have insurance and you are struggling to pay for your medicines, we encourage you to apply. Please note:
- Fill out the sections completely – please refer to the checklist on the application.
- Attach proof of income if required.
- Be sure that you and your doctor sign and date the application.
- If you have insurance, please include a detailed list of prescription and medical expense for the household.
- Send to the fax number
or address on your application.
Please begin with the application process by downloading an
application from this website or by calling 1-800-222-6885 to request
delivery of an application by mail or fax.
Patient Assistance Programs that provide medication at no cost are
available to qualified people who reside in the United States and for
some products Puerto Rico. Savings cards are available in the US and
for some products Puerto Rico.
Participation in our programs is free; we do not collect any
fees from people seeking our assistance.
If we receive your application with all the necessary paperwork and
signatures, we will usually complete the evaluation within two
business days and contact you and your health care provider with the
outcome. Please closely review the application before submitting it.
Missing or incomplete information, documentation, and signatures often
Most programs do require proof of income. Please refer to the
program application. We prefer to receive your most recent tax return;
however other forms of proof are acceptable.
Please include information with your application regarding your financial circumstances. This will allow us to accurately assess your eligibility for patient assistance or for alternate coverage such as Medicaid.
If you have experienced a recent hardship such as a job loss or other
reduction of income that is not reflected in your tax return, please
describe your current income situation when you submit your
We will contact you and/or your healthcare provider about your
This can vary by medication. For some products we will ship the
medication within seven days of an application approval. For other
medications, we will contact you or your health care provider to
schedule medication delivery.
Yes. Please review the application listed under the specific medications you are applying for.
If the application is the same, only one application is needed. If
the medications are listed on separate applications, you will need to
complete them separately.