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.

How to Apply

Please either download the application below (if available) or go to the program website for more information on how to apply. Once you fill out your application, send it to the address on the application. Remember not to send program applications to PPA.

Product(s) Covered by Program

  • A

    • ARIMIDEX® (anastrozole) Tablets
  • B

    • BRILINTA® (ticagrelor) 60mg Tablets
    • BRILINTA® (ticagrelor) 90mg Tablets
    • BYETTA® (exenatide) Injection
  • D

    • DALIRESP® (roflumilast) Tablets 500mcg
  • F

    • FARXIGA® (dapagliflozin) Tablets
    • FASLODEX® (fulvestrant) Injection
  • I

    • IMFINZI (durvalumab)
    • Iressa® (gefitnib) tablets 250mg
  • K

    • KOMBIGLYZE® XR (saxagliptin and metformin hydrochloride extended-release) Tablets
  • L

    • LYNPARZA™ (olaparib) Capsules
  • M

    • MOVANTIK™ (naloxegol) Tablets
  • P

    • PULMICORT FLEXHALER® (budesonide inhalation powder, 90 mcg &180 mcg)
    • PULMICORT RESPULES® (budesonide inhalation suspension)
  • S

    • SYMBICORT® (budesonide/formoterol fumarate dihydrate) Inhalation Aerosol
    • SYMLIN® (pramlintide acetate) Injection
  • T

    • TAGRISSO™ Tablet
    • TUDORZA® PRESSAIR® (aclidinium bromide inhalation powder) 400mcg
  • X

    • XIGDUO™ XR (dapagliflozin and metformin hydrochloride extended-release) Tablets
  • Z

    • ZOLADEX® (goserelin acetate implant) 10.8 mg 3-month depot
    • ZOLADEX® (goserelin acetate implant) 3.6 mg 1-month depot
    • ZURAMPIC® (lesinurad) Tablets 200 mg