1). Prescription Bliss

www.prescriptionbliss.com

Eligibility:
• Each program has different requirements, but many of our
patients come to us who are on Medicare and have a Part D plan and are unable to afford their copays or find themselves in the coverage gap of their prescription plan.
• If your insurance company has denied paying for your prescriptions or you have a high copay or coinsurance responsibility.

Instructions:
• Call 1-877-792-5477 or go to the website prescriptionbliss.com to apply
• Click on Apply Now
• Click on Begin Application


2). azandmeapp.com | 1-800-292-6363

Eligibility:
• You must be a resident of the United States
• You must not be receiving: Prescription drug coverage under private (commercial) insurance or a government program (except for Medicare) or any other assistance to help pay for your medication
• Your annual income must be at or below 500% of the Federal Poverty Level for specialty products or 300% of the Federal Poverty Level for primary products
• If you are a Medicare Beneficiary you must not be eligible for or enrolled in Low Income Subsidy (LIS) for Medicare Part D
• If you have experienced a life-changing event in the past year, and your current enrollment status does not reflect this, you may still be eligible.
Some examples of this type of event are:
a. Loss of Employment
b. Change In Income
c. Loss of (or Change In) Prescription Drug Coverage d. Marriage
e. Change in Address

Instructions:
• Four Ways To Apply (Phone, Online, Fax or Mail)
• Go To azandmeapp.com
• Start My Enrollment
• Please Choose the Role That Fits You Best
• Click on Next
• Type In Your Medication
• Click Next
• Fill in Patient Information
• Click Next
• Fill In Prescriber Information
• Click Next
• Consent
• Click Next
• Income
• Click Next
• Insurance


3.) RX Assistant

www.rxassistantprograms.com/

Eligibility:
Its best to call to see if you qualify.
• U.S. citizen or resident
• Does not have insurance or insurance doesn't cover medication.
• On Medicare or in donut hole/coverage gap

Instructions:
• Go to rxassistantprograms.com to fill out online form
• Call 1-888-344-8915