How Do I Apply

It's simple.

1. Click on the medication you need on the right.

2. Complete the application.

  • Fill out the sections completely – please refer to the checklist on the application.
  • Attach proof of income if required.
  • Be sure that you and your doctor sign and date the application.
  • If you have insurance, please include a detailed list of prescription and medical expense for the household.

3. Submit the completed application by mail or fax.

Send to the fax number or address on your application.

What happens next?

We will contact you and your doctor about your application within a week to let you know if you are approved for assistance. If the application was missing information we will ask you or your doctor to provide missing information. Once received we will evaluate your application.

If approved for assistance we will ship your medication. If you are approved for assistance with HUMIRA we will contact you to schedule delivery at a time that you can be home to receive it. We evaluate all applications on a case by case basis and consider people with insurance.