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.

Most application forms can be viewed here, printed out and filled out by hand. In most cases, you will have to mail them in an envelope to the address found on the form or the fact sheet. A few forms are fillable online—meaning you can fill them out while on your computer and print them.

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