Step 1: What you will need to submit the AZ&Me application
You will need to provide:
- The name and formulation (tablet, capsule, injection, etc.) of the AstraZeneca medication prescribed to you
- Personal information:
- Home address and phone number
- Doctor’s name and contact information
- Health insurance information
- Adjusted gross income
- Household size
Step 2: Determining Eligibility for AZ&Me
If you are eligible for the program, you will be notified of your approval and your enrollment end date.
If you are not eligible, you will be notified that your enrollment request was denied. You will also be provided with the reason for the denial along with information on other medication assistance resources.
Step 3: Your Doctor Sends Your Prescription to AZ&Me
Once you are enrolled, AZ&Me will contact your doctor’s office to get the prescription for your AstraZeneca medication. The prescription will be sent to our pharmacy partner.
Step 4: The Pharmacy Fills Your Prescription and Your Medication Is Delivered
Our pharmacy partner will fill your prescription and up to a 90-day supply of medication will be shipped at no cost directly to your home (or doctor’s office, if needed).
Step 5: Request a Refill
Either you or your doctor can request a refill of your medication.