Helping you get the medicines you need.
The AZ&Me™ Prescription Savings program for people without insurance is designed to provide AstraZeneca medicines at no cost to qualified patients. This patient prescription assistance program can help patients who do not have prescription drug coverage and who meet other eligibility criteria.
Highlights
- You may be eligible to receive up to a 90-day AstraZeneca prescription at no cost, delivered to your home or physician’s office. Review the list of medicines available through this program.
- You or your doctor can request refills when needed.
- You can get one-on-one support to help you identify and access health and drug coverage and services for which you may qualify.
- Once accepted, you remain enrolled for one year. At the end of that year you can reapply.
Are you eligible?
You may be eligible if you meet the following criteria:
-
You have an annual household income* equal to or less than:
$30,000 for a single person
$40,000 for a family of two
$50,000 for a family of three
$60,000 for a family of four
$70,000 for a family of five
* Current income limits are based on 2007 guidelines and might change; income limits might be higher in Alaska and Hawaii. -
You do not receive drug coverage under any private insurance or any other coverage that provides assistance to help pay for medicines,
such as:
- Employer furnished or private drug coverage
- Military or veteran benefits
- Medicare Part B (covers some medicines)
- Medicare Prescription Drug Program (Part D)
- Medicaid
- State assistance program for medicines (SPAP, SCHIP, PACE, etc.)
What if you are in Medicare and Qualify for Limited Income Subsidy?
Patients who are in Medicare and may be eligible for the Limited Income Subsidy can apply to the AZ&Me™ Prescription Savings program for people without insurance.
- When you apply to this program, you will receive information and one-on-one education designed to help with the Limited Income Subsidy application process.
- During the processing of your Limited Income Subsidy application, you will be temporarily enrolled in the AZ&Me™ Prescription Savings Program, and you can receive your AstraZeneca medicines.
- Once the Social Security Administration confirms that you have qualified for the Limited Income Subsidy, you are no longer eligible for the AZ&Me™ Prescription Savings program because you will have access to affordable, comprehensive coverage.
- If the Social Security Administration denies your application for the Limited Income Subsidy, our counselors can help you complete the enrollment process for the AZ&Me™ Prescription Savings program for people without insurance, so you can continue receiving your medicine.
What if you do not qualify for the Limited Income Subsidy and are not enrolled in Medicare Part D?
- You may apply to the AZ&Me™ Prescription Savings program for people without insurance and get one-on-one support to help you identify and access health and drug coverage and services for which you may qualify.
- If you have not enrolled in a Part D plan, and if you meet the other enrollment criteria, you may be eligible for the AZ&Me™ Prescription Savings program for people without insurance.
How to apply
The AZ&Me™ Prescription Savings program for people without insurance offers a simple application process that can help you receive your medicines quickly.
It’s easy to apply to this program:
-
Download the application ( In English | En Español) or complete the application online
- Have your doctor's office help you complete the appropriate sections of the application.
- Include the required financial information and your signature.
- If you are not a US citizen, you must also provide a valid US Green Card number or a confirmation letter from the government stating that you have applied for a US Green Card or a work visa number.
- Get a current prescription for an AstraZeneca medication from your doctor.
-
Mail the completed application, financial information, and prescription to:
AZ&Me™ Prescription Savings Programs
PO Box 66551
St. Louis, MO 63166-6551
OR
Fax: 1-888-810-5282 - If you have questions about the application process, or to learn more about whether or not you or a family member may qualify for this program, call 1-800-AZandMe (1-800-292-6363), Monday through Friday, 8:00 a.m. TO 8:00 p.m. EST.
AZ&Me™ Prescriptions Savings program for people without insurance medicine list
These are the medicines you may access through the AZ&Me™ Prescription Savings program for people without insurance. Click on a medicine name for more details, to access the product web site, or to read the full prescribing information.
If you are seeking assistance for ONGLYZA please contact the BMS Patient Assistance Foundation at 1 (800) 736-0003 for help or visit their web site www.bmspaf.org for Program information or an application. Please note that the AZ&Me™ Prescription Savings Programs may have different eligibility requirements than the BMS Patient Assistance Foundation Program.
Learn about other assistance programs
In addition to the programs offered by AstraZeneca, other organizations also offer programs that make medicines affordable for people who need assistance. Learn more about additional programs offered by AstraZeneca and other organizations.
