Our specialists recommend having the following information available in order for you to achieve the easiest and most accurate application process.

Monthly Income

Personal information including Social Security Number

Physician's Name, Address, and Phone Number

Name and dosage of the prescription medications you are applying for

See if you're qualified for prescription assistance enrollment with the help of Rx Aid, by filling out a short online form.

After you qualify, fill out the full online application. This information will be used to enroll you in any patient assistance programs you apply for, to obtain prescription drugs.

$20.00 Application Fee

Rx Aid requires a one time, non-refundable, $20,00 application fee. This fee will be accessed at the time of the initial phone interview (after you've submitted a completed application).

Monthly Prescription Managment Fee

While you will save on your prescription costs with the help of Rx Aid, we do require a fee of $12.00 for every enrollment application we manage.

For example, if Rx Aid manages 3 prescription applications for you on a monthly basis, your fees are $36.00 / month.

This fee will be charged once a month on the 4th of every month, after your completed PAP applications have been sent to the pharmaceutical companies.

Our monthly fee is required to keep you enrolled with the proper patient assistance programs on a month to month basis. Pharmaceutical companies are constantly updating their guidelines, and because of this it is difficult for many individuals stay enrolled. In short, our monthly fee keeps us working for YOU.

Accepted Payments

Payment is accepted in the form of Visa, Mastercard, or Banking Information. (A voided check will need to be attached with banking information)

After your application(s) have been prepared and processed correctly for the pharmaceutical companies, you will receive a personal application packet.

Here is what you can expect to see included in your packet:

IRS Income Documentation
(If you did not file a Federal Income Tax Return for the prior year, you must complete this form)

Completed Pharmaceutical Applications
(You will need to sign your completed application in the proper highlighted areas.)

Rx Aid Agreement Contract
(You will need to sign a simple contract that authorizes Rx Aid to act as your advocate and allow pharmaceutical companies to access the required medical and financial information to provide proof that you meet their qualifications.

(This agreement also authorizes the drafting of fees from the account provided for services provided by Rx Aid Inc.)

HIPAA Release(Health Insurance Protability and Accountability Act)
(A US regulation that gives patients greater access to their own medical records and more control over how their personally identifiable health information is used. The regulation also addresses the obligations of healthcare providers and health plans to protect health information.)

Pre-paid, pre-addressed envelope addressed to Rx Aid Inc.
For the return of your completed documents to Rx Aid for final review and proper submission to the pharmaceutical company.

Sign all documents within your Rx Aid Application Kit. Have your physician sign where needed, and obtain an original copy of prescriptions.

Once you have your original prescriptions, pharmaceutical applications (signed by you and your physician), Rx Aid contract, and release form completed; simply place the documents in the pre-labeled envelope that was included in your packet, and send it back to us in the mail.

*Note:
It is extremely important that you return your documents with your proof of income. Pharmaceutical companies require proof that you meet their requirements for yearly generated income, without this you application MAY NOT be considered. If you did not file income last year, please be sure you filled out the IRS Income Document included with your packet.

Acceptable documents for proof of income include the following:

Federal income tax form.(1040, 1040A, 1040EZ, 1040X, 1722, 8453, 8879, or 1099INT)

Yearly Benefits statement. A letter of verification can be obtained from the Social Security Administration at (800) 772-1213

W2 Tax Statment

Social Security, Pension, or Railroad Retirement Statements

Statements of interest, dividends, or other income

That's all. It generally takes 2-6 weeks for the arrival of the first set of prescriptions to you, from the pharmaceutical company. Your medications will be delivered to your doctors office, or to your front door. Rx Aid does not physically handle the medication.

If you have further questions please review our FAQs or call us with your questions to begin your application process today:

Local: (937) 610-9060 | Toll Free: (877) 610-9060