Apply to AZ&Me Prescription Savings Program

Free AstraZeneca medicines for US residents with limited income who are uninsured or on Medicare. Apply directly with the program; here is what it asks and what happens next.

Who can apply?

Yearly household income before taxes, 2026 limits
Medicines1 person2 people3 people4 people
Airsupra, Baxfendy, Bevespi Aerosphere, Breztri Aerosphere, Lokelma
and 11 moreCalquence, Etcamah, Fasenra, Imfinzi, Imjudo, Lynparza, Saphnelo, Tagrisso, Truqap, Farxiga, Xigduo XR
$47,880$64,920$81,960$99,000
Wainua$79,800$108,200$136,600$165,000

Primary and specialty medicines: annual adjusted gross household income at or below 300% FPL ($47,880 for 1 in the 48 states; higher for Alaska and Hawaii). Rare disease (Wainua): 500% FPL. Below 150% FPL may need a Medicaid or LIS denial letter. Effective January 26, 2026.

Excluded: commercial (private or employer) insurance and any government insurance other than Medicare (form lists Medicaid, SCHIP, TRICARE, VHA, IHS). Medicare patients must not be eligible for or enrolled in Extra Help (LIS). Must not receive any other medication assistance. Brilinta was removed January 1, 2026. Medicare enrollees are not auto re-enrolled for 2027. People with a life-changing event in the past year (job loss, income change, lost coverage) may still qualify.

Not for people whose employer or plan sends them to the program as a condition of coverage.

Then what?

  1. Sign

    • patient application with patient authorization (includes HIPAA-style release, soft credit check for income, attestation of no other drug coverage)

  2. Attach

    • Medicaid or LIS denial letter may be required if below 150% FPL
    • income documentation if requested (program estimates income by soft credit check)

  3. Your prescriber

    • completes the AZ&Me Provider Form with prescription and wet signature
    • faxes it from the office to 1-877-239-0867
    • may ePrescribe to the AZ&Me pharmacy instead (New York prescribers must ePrescribe or attach a separate prescription)

  4. Send

    • Fax 1-877-239-0867

Rather apply online? Apply on the AZ&Me Prescription Savings Program site.

Questions: call AZ&Me Prescription Savings Program at 1-800-292-6363. Up to one year; Medicare enrollees must re-enroll each year..

Free. EveryCard Rx isn't paid by the program and never sends anything for you. Form , rules checked 2026-11-06 from the program's own pages. Something out of date? Tell us.