The Application Forms Center makes it easy to access Application Forms and Fact Sheets for Rx assistance programs.
There are four easy ways to search for an application form:
- Search by Drug (you may select the brand name or generic name);
- Search by Form Category;
- Search by State; and
- Search by Form Date.
After selecting one of the search options above, you will be able to narrow your search criteria.
A list of programs and forms will then be displayed that match your search criteria. You can click
on the program name to open a printable Fact Sheet or click on the application name to open the printable
form. Some of the forms are marked fillable, indicating that you can complete the form electronically.
BenefitsCheckUp strives to maintain the most current database of programs and application forms possible.
Please feel free to contact BenefitsCheckUp Customer Support at
questions or program additions.
Thank you for using this service.