Tip for Varies by program

The NeedyMeds drug discount card is free and can save 0-80% on prescription drugs at participating pharmacies — no eligibility requirements

Tip for Varies by program

Search NeedyMeds by drug name to find all available assistance programs for each medication

Tip for Varies by program

NeedyMeds also lists disease-specific assistance programs, state assistance programs, and free/low-cost clinics

Financial Assistancemoderate

NeedyMeds / RxAssist Program Finder Application

Varies by program · NeedyMeds / Various Foundations

Applications for disease-specific foundation assistance programs that help with medication costs, insurance premiums, and copayments. Foundations include HealthWell, PAN Foundation, Patient Advocate Foundation, and others.

Form Details

Total fields: 35
Auto-fillable: 22 (63%)
Time without BeneFill: 25 minutes
Time with BeneFill: 7 minutes
Time saved: 18 minutes
Filled by: patient
Frequency: annual

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Where to Submit This Form

🌐

Search and apply through NeedyMeds.org

https://www.needymeds.org/

NeedyMeds is a free information resource — applications are submitted to individual assistance programs found through the site.

🏢

Call NeedyMeds helpline at 1-800-503-6897

Available Monday through Friday, 9 AM - 5 PM ET.

Filing Deadline

Varies by individual program. NeedyMeds itself is a directory — deadlines are set by each listed assistance program.

Required Attachments

📎 Varies by the specific assistance program
📎 Typically: proof of income, insurance status, prescription information, and physician signature
📎 NeedyMeds provides a free drug discount card that requires no application

Processing Time

NeedyMeds drug discount card: immediate. Individual assistance program applications: 2-8 weeks depending on the program.

What Happens Next

For the NeedyMeds discount card, present it at the pharmacy for immediate savings. For individual assistance programs, follow up directly with the program for application status.

Tips for This Form

✓ The NeedyMeds drug discount card is free and can save 0-80% on prescription drugs at participating pharmacies — no eligibility requirements
✓ Search NeedyMeds by drug name to find all available assistance programs for each medication
✓ NeedyMeds also lists disease-specific assistance programs, state assistance programs, and free/low-cost clinics
✓ Apply to multiple programs simultaneously if you take several expensive medications

More Financial Assistance Forms

Patient Assistance Program Enrollment

PAP Enrollment (manufacturer-specific) · Pharmaceutical Manufacturers (Pfizer, Lilly, Merck, J&J, AbbVie, etc.)

Application for free or reduced-cost medications for uninsured or underinsured patients. Requires income documentation and prescriber attestation. Each manufacturer has its own form and eligibility criteria.

Manufacturer Copay Card / Coupon Enrollment

Copay Card (manufacturer-specific) · Pharmaceutical Manufacturers

Enrollment for manufacturer copay reduction programs for commercially insured patients. NOT available to Medicare, Medicaid, or other federal program beneficiaries. Some insurers have accumulator adjustment programs that prevent copay card amounts from counting toward deductible.

340B OPAIS Registration

340B OPAIS · HRSA Office of Pharmacy Affairs

Online registration in the 340B Office of Pharmacy Affairs Information System. Required for covered entities (FQHCs, hospitals, etc.) before purchasing 340B-priced drugs. Requires supporting documentation for hospital classification.

340B Annual Recertification

340B Recertification · HRSA

Annual recertification of eligibility to participate in the 340B program. Failure to complete results in program termination. Authorizing Official must verify compliance with all program requirements.

State Pharmaceutical Assistance Program Application

SPAP Application (state-specific, e.g., NJ PAAD, NY EPIC, PA PACE) · State Pharmaceutical Assistance Programs

Application for state-funded prescription drug assistance. Eligibility typically based on age, income, and residency. Available in 20+ states. May coordinate with Medicare Part D for additional savings.

Extra Help / Low-Income Subsidy (LIS) Application

SSA-1020 · Social Security Administration

Application for Extra Help (Low-Income Subsidy) with Medicare Part D prescription drug costs. Reduces premiums, deductibles, and copayments for qualifying beneficiaries. Can save an average of $5,300 per year.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the NeedyMeds / Various Foundations or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.