Co-Pay Relief Program

Eligibility: Insured and have coverage for medication. Reside and receive treatment in the United States. May Financially qualify for Household income guidelines ranging from 300% or less of the federal poverty level to meet the Cost of Living Index.

Application Process: CPR offers four (4) points of entry into the program accepting applications daily. The program offers online service for patients, providers and pharmacies allowing them to apply electronically through a secured, web-based application portal available 24 hours a day. The program continues to provide personalized assistance through a dedicated professional representative, by phone, who will guide them through the application process and answer any questions you may have.

Required Documentation: In order to make a final eligibility determination on your application, the following information is all that you need: 1. Signed, completed application 2. Physician Form, completed and signed by your treating physician 3. Copy of signed federal tax return from most recent tax year (pages 1 & 2 only) In the rare case that you are unable to provide a federal tax return from most recent year, we can consider alternate documents to verify your income.

Fees: No fee for service.

Coverage Note: United States.

Languages: Spanish