Application Forms Center
Need information or want to apply for a particular program?
We have program fact sheets and over 600 application forms for programs that can help you pay for prescription drugs and other health-care costs, including state pharmacy programs, patient assistance programs, and your state's Medicaid and Medicare Savings Programs. In general, most company-sponsored patient assistance programs are designed for people with lower incomes (if single, annual income up to $22,000, or if married, annual income up to $30,000). However, each program has its own set of guidelines and should be contacted directly for eligibility determinations.