AZ&Me(tm) Prescription Savings Program for people without insurance

AstraZeneca

Contact Information
1-(800) 424-3727 (phone)
1-(888) 810-5282 (fax)
Physician requests should be directed to:
AZ&Me Prescription Savings Program
AstraZeneca Foundation
P.O. Box 66551
St. Louis, MO 63166-6551
1-(800) 424-3727 (phone)
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.
Eligibility:
Patient applications are evaluated on a case-by-case basis by the Program. Eligibility is based on income levels and absence of private prescription insurance, third-party coverage, or participation in a public program including the Medicare Limited-Income Subsidy. Income eligibility is based on levels at or below $30,000 for an individual; $40,000 for a couple; $50,000 for family of three; $60,000 for a family of four. The Program requires proof of of income and US residency (Social Security #, work visa # or green card #). Patients approved into the Program will receive an acceptance letter and should receive their shipment of product within 1-2 weeks. Patients denied to the program will receive a denial letter if the individual does not meet the eligibility guidelines of the Program. Enrollment is for 12 months with reapplication at month 10.
Other Information:
If requesting Arimidex, Casodex, Nolvadex, Faslodex or Zoladex, please call the AstraZeneca Cancer Support Network at 866-992-9276 for assistance. If approved, a three-month supply of the medication is sent directly to the patient's home or other designated location with the exception of Seroquel, Faslodex, and Zoladex from the Program mail-order fulfillment pharmacy. Refills can be requested by the patient or prescribing physician. With the shipment, patient receives instructions on how to request next supply of medication. Patient/family members/physician can obtain information about and application forms for the Program by calling (800) 424-3727. An online application is available and can be completed at http://www.astrazeneca-us.com/help-affording-your-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
  • Pulmicort Flexhaler®
  • Pulmicort Respules®
  • Rhinocort Aqua®
  • Seroquel XR®
  • Seroquel®
  • Symbicort®
  • Toprol® XL
  • Zoladex®
  • Zomig ZMT® Oral Disintegrating Tablets
  • Zomig® Nasal Spray
  • Zomig® Tablets