AZ&Me TM Prescription Savings Program for people with Medicare Part D

AstraZeneca

The AZ&Me Prescription Savings program for people with Medicare Part D is designed to provide AstraZeneca medicines at no cost to qualified patients enrolled in a Medicare Part D prescription drug coverage plan but who are having difficulty affording their AstraZeneca medicine(s). Highlights 1. AstraZeneca medicines provided at no cost 2. There is NO cost to sign up for this program 3. Enrollment is on a calendar year basis 4. Medicines are mailed to the home or physician's office 5. You or your doctor can request refills 6. Apply by phone or download an application at www.azandme.comAre you eligible? If you are enrolled in Medicare Part D, you may be eligible for the program if you meet the following criteria: 1. Enrolled in Medicare Part D; 2. You are an individual with an annual income at or below $35,000, or if a couple, at or below $48,000; 3. You are taking an eligible AstraZeneca medicine How to apply The AZ&Me Prescription Savings program for people with Medicare Part D offers an easy application process that can help you receive your AstraZeneca medicines quickly.

What if you are enrolled in Medicare and Qualify for the Limited Income Subsidy? Patients who are have Medicare Part D and may be eligible for the Limited Income Subsidy ("LIS") can apply to the AZ&Me Prescription Savings program for people with Medicare Part D. When you apply to this program, you will asked to apply for the Limited Income Subsidy (also known as Extra Help). During the processing of your LIS application, you may be temporarily enrolled in the AZ&Me Prescription Savings Program. This means you could receive your AstraZeneca medicine(s) from the Program while you wait for your LIS application results. Once Medicare confirms that you have qualified for the LIS, you are no longer eligible for the AZ&Me Prescription Savings program because you will have access to affordable, comprehensive coverage. You will no longer receive AstraZeneca medicines through the AZ&Me Prescription Savings Program. If Medicare denies your application for LIS, our assistance specialists can help you complete the enrollment process for the AZ&Me Prescription Savings program for people without insurance, so you can continue receiving your AstraZeneca medicine(s).

To apply to the Program: Download the application ( In English | En Espanol), or call 1-800-AZandMe (292-6363). 1. Include the required financial information and your signature. * Acceptable forms for financial documentation include a copy of last year's federal income tax returns for yourself, your spouse and dependents, a Social Security Benefit Verification Statement or all income statements from jobs (W-2 or 1099) 2. Include a valid prescription for your AstraZeneca medicine(s) from your doctor. 3. Mail the completed application, financial information, and prescription to: AZ&Me Prescription Savings Programs PO Box 898, Somerville, NJ 08876 OR Fax: 1-800-961-8323. If you have questions about the application process, or to learn more about whether or not you or a family member may qualify for this program, call 1-800-AZandMe (292-6363), Monday through Friday, 8:00 AM-6:00 PM EST.

Contact Information AZ&Me Prescription Savings Program PO Box 898 Somerville, NJ 08876
Contact Information
1-(800) 292-6363 (phone)
1-(800) 961-8323 (fax)
1-1-800-AZandMe (vanity_phone)
How to Apply:
Select one of the links below to download the application or go to the program site for more information on how to apply. Once you fill out your application, send it to the address on the application. Do NOT send it to RxResource.
Eligibility:
Patient must be enrolled in Medicare Part D, have an income at or below $35,000 as an individual or $48,000 as a couple and be taking an eligible AstraZeneca medicine.
Other Information:
Program Highlights: 1. AstraZeneca medicines provided at no cost 2. There is NO cost to sign up for this program 3. Enrollment is on a calendar year basis 4. Mailed to the home or physician's office 5. You or your doctor can request refills 6. . Apply by phone, or download an application at www.azandme.com
Product(s) covered by program:
  • Arimidex®
  • Atacand®
  • Atacand® HCT
  • Brilinta®
  • Bydureon®
  • Byetta®
  • Crestor®
  • Farxiga™
  • Faslodex®
  • Kombiglyze™XR
  • Merrem I.V.®
  • Nexium®
  • Nexium® I.V. Injection
  • Nexium® Oral Suspension
  • Onglyza®
  • Pulmicort Flexhaler®
  • Pulmicort Respules®
  • Rhinocort Aqua®
  • Seroquel XR®
  • Symbicort®
  • Symlin®
  • Toprol® XL
  • Zoladex®