How to Apply:Select one of the links below to download the application or go to the program site for more information on how to apply. Once you fill out your application, send it to the address on the application. Do NOT send it to PPA.
- Click here to visit the program's web site.
Eligibility:
Patient must be enrolled in Medicare Part D, have an income at or below $30,000 as an individual or $40,000 as a couple, and patient has spent less than 3% of annual household income on outpatient prescritption drugs this calendar year. This program is only valid for AstraZeneca medicines.
Product(s) covered by program:
- Accolate®
- Arimidex®
- Atacand®
- Atacand® HCT
- Casodex®
- Crestor®
- Faslodex®
- Merrem I.V.®
- Nexium®
- Nexium® I.V. Injection
- Nexium® Oral Suspension
- Prilosec
- Prilosec
- Pulmicort Flexhaler®
- Pulmicort Respules®
- Rhinocort Aqua®
- Seroquel XR®
- Seroquel®
- Symbicort®
- Toprol® XL
- Zoladex®
- Zomig ZMT® Oral Disintegrating Tablets
- Zomig® Nasal Spray
- Zomig® Tablets