Patient Assistance Application Overview

Is the online application right for you?

Our online application is for use by people over the age of eighteen and seeking assistance (the patient) for either HUMIRA® (adalimumab) or SKYRIZITM (rizankizumab-rzaa).  We will ask you to register and complete an application. Before you start, please make sure that you have electronic copies of the necessary documents, listed further below.

While you can apply online, we will also need the health care provider who has prescribed your medication to submit application documents separately. Once you have submitted your application and supporting documents, we will contact your health care provider to obtain your prescription and other needed information.

This website will guide you through the steps needed to complete your application and will allow you to sign up for text or e-mail updates from the program:

Step One: Enter your information into our website and create an account.

Step Two: Follow the screens to provide income and insurance information for the application process. The system will prompt you to upload copies of your tax returns or other income documents and insurance cards if you have them.   

Step Three: Upload any additional documents that may help us understand your difficulty accessing your medicine.

Step Four: Review our privacy notice and program terms to understand how we use your personal data, acknowledge your understanding and submit.

We will contact your prescribing doctor for the remaining information. We also will notify you and your health care provider after we have reviewed your application. If you are approved for assistance, you may use this site to schedule refill deliveries based on the prescription from your health care provider.  

What documents must be electronically available?

• Income documents: Your Federal Tax Return for the most current filing year is the preferred income document. If you do not have a tax return, we will accept copies of your pay stub (for at least two pay periods), social security statement, social security disability statement, W-2 form, or 1099-R form.
  
  
• Insurance and Expense Information: If you have insurance, you will need to provide the following documents:
  • Prescription or medical insurance card – a front and back copy of the card is needed.
  • List of the prescription medications from your pharmacy. If a pharmacy printout is not available, please include a medication list.
  • Medical expenses for everyone in the household.
    
    

Click here for an optional expense form that can be used to document your prescription and medical expenses.

What if I am not the patient OR I do not have all of my documents available electronically?

Step One: Please download and print the application to submit by mail or fax: HUMIRA | SKYRIZI

Step Two: Follow the instructions on the first page to complete the application.

Step Three: Obtain the patient’s signature and date in all needed sections.

Step Four: Gather copies of the supporting documentation to include with the application.

Step Five: Take the application to your health care provider. He or she should complete the page marked ‘PRESCRIBER PRESCRIPTION AND CERTIFICATION‘ to include signing and dating the form at the bottom.

Step Six: Please fax or mail the completed application and copies of your documents to us. Note that you and your health care provider can send to us separately.

myAbbVie Assist
D-617927, AP5 NE 1 N. Waukegan Rd.
North Chicago, IL 60064
Phone: 1-800-222-6885
Fax: 1-866-250-2803

If you need help at any point during this process, please call us at 1-800-222-6885 Monday through Friday 7:00 AM to 7:00 PM Central Time.