AstraZeneca Foundation Patient Assistance Program (PAP)

AstraZeneca Foundation Patient Assistance Program (PAP)

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AstraZeneca Foundation Patient Assistance Program (PAP)

Sponsor Organization

Prescription Medication Assistance Organization Contact
Patient Assistance Program (PAP)
AstraZeneca Foundation
PO Box 66551
St Louis, MO 63166-6551
Phone: (800) 424-3727

Medications sent to: Patientís Doctor

Prescription Medications/Products Covered:
Accolate Tablets
Atacand HCT
Emla Cream
Plendil Tablets
Pulmicort Respules
Pulmicort Turbuhaler
Rhinocort Aqua Nasal Spray
Toprol XL

Program Information And Resources:
AstraZeneca Foundation Patient Assistance Program (PAP) Application Form

Program Information And Resources:
AstraZeneca Foundation Patient Assistance Program (PAP) Application Form in Spanish

Program Information And Resources:

Program Eligibility Requirements:
Patient Application Forms are evaluated on a case-by-case basis by the AstraZeneca Foundation. Eligibility is based on income level/assets and absence of outpatient private prescription insurance, third-party coverage, or participation in a public program. Income eligibility is based upon multiples of the U.S. poverty level adjusted for household size.

Patients approved into the Patient Assistance Program (PAP) should receive their shipment of product within 1-2 weeks. They will not receive an acceptance letter. However, patients and their physicians will receive a denial letter if the patient does not meet the financial guidelines of the Patient Assistance Program (PAP).

Additional Information and/or Requirements (known):
If approved, a three-month supply of the medication is sent directly to the patient's home or other designated location with the exception of Seroquel, Faslodex, and Zoladex from the mail-order fulfillment pharmacy. Refills may be written by the physician. With the shipment, patient receives instructions on how to request next supply of medication.

Patient/family members/physician can obtain Application Form forms from the AstraZeneca Foundation by calling (800) 424-3727. Physicians also can obtain a packet of Application Forms from their AstraZeneca sales representative. Application Form forms can also be obtained from the AstraZeneca website:

ReApplication Form is required every 12 months. A reApplication Form is automatically sent to enrolled patients.

Enrollment in the program requires a valid Social Security or Green Card number. Patient is required to submit financial documentation.

Link: Prescription Medication Program Website





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