apply
getting started
Tips for online application
Our one-time online application takes about 20 minutes to complete. To obtain a list of
helpful items for completing your online application, view our getting started.
Standard patient prequalification & application
See if you're qualified for prescription assistance, create your account, and fill out our easy one-time online application.
See if you're qualified for prescription assistance, create your account, and fill out our easy one-time online application.
Rx Aid patient prequalification & application for clinic use.
Rx Aid's application devoted to helping clinics and their caseworkers enroll patients into prescription assistance programs.
Rx Aid's application devoted to helping clinics and their caseworkers enroll patients into prescription assistance programs.
Rx Aid's Application, and Enrollment Service INCLUDES:
Step-by step assistance- Online Prequalification
- Mailed Application Kit (includes your completed personalized PAP forms from each
pharmaceutical company)
- Highlighted Form Signature Fields (for Patients and Doctors)
- Online & Mailed Application Review (we make sure your information is accurate
and forms are properly signed)
- Monthly Subscription Service (we're here to answer your questions and help you in
the process on a day to day basis)
- Medication Re-orders (we help to keep you enrolled in each PAP on a month-to-month
basis)
- Application Renewals & Annual Recertification (Rx Aid works with you to re-apply
for medications, new or old)
- Low Application Fee ($12.00 per enrollment application each month)
