- 1-888-4PPA-NOW (1-888-477-2669)
- Patient FAQs
Questions about Getting Started
- How do I get an application?
- What questions will applicants be prompted to answer?
- How can I tell the status of my application?
- I experienced technical difficulty while attempting to print my application. Does this mean that my private medical information has been compromised?
How do I get an application?
You may obtain an application through the PPARx program. It will gather information needed to see if you may qualify and will then create an application form that you can print out.
What questions will applicants be prompted to answer?
You should be prepared to provide information about the patient, such as:
- Age
- State of residence and ZIP code
- Estimated gross annual household income
- Number of people living in household
- Brand name of prescription medicines they are currently taking or have been prescribed
- Type of health insurance and/or prescription coverage (if applicable)
Your responses to these questions are completely confidential.
How can I tell the status of my application?
You will need to contact the program directly to get the status of your application.
I experienced technical difficulty while attempting to print my application. Does this mean that my private medical information has been compromised?
Our systems are designed to delete your personally identifiable information automatically once your session on the Website ends. When you are in the process of filling out an application on the Website, your information is protected by SSL certificate encryption, one of the most widely used online secure transaction mechanisms in the world.
