Program Details
ASTRAZENECA PHARMACEUTICALS
AZ & Me Prescription Savings Program for people with Medicare
()
|
| CONTACT
INFO |
|
| Address: |
1 Medimmune Way
Gaithersburg, MD 20878 |
| Phone: |
1-800-292-6363 |
Provider Phone: |
|
| Fax: |
1-877-239-0876 |
Website: |
AZ & Me Website |
|
| ELIGIBILITY
|
|
| Eligibility
Info: |
Visit AZ&Me website to apply online or to download an application.
Patient must meet qualifying income criteria.
Patient must be enrolled in Medicare and are not enrolled in Limited Income Subsidy (LIS).
NOTE: Effective May 1, 2026, the AZ&Me program will no longer accept new patients for FARXIGA and XIGDUO XR. Actively enrolled patients will continue to receive assistance for FARXIGA and XIGDUO XR until December 31, 2026
|
| |
Couple |
|
% FPL |
| Income at or below: |
Not
Published |
| Medical expenses
can be deducted from reported income: |
Not
Published |
| Social security requested on form: |
No |
| US citizenship/residency specified:
|
Yes |
|
|
APPLICATION |
|
| Attachments
Required: |
Financial
Prescription
Year-to-date prescription spend history
|
Physician
License #
Required: |
State
NPI
|
Prescriber
Signature
Allowed: |
Physician
|
Application
may be
faxed: |
Yes
|
Eligibility
determination
letter sent: |
Providers receive a fax, patient receives letter and phone call
|
|
| MEDICATION |
|
| Receives: |
Medication
|
| Shipped To: |
Either Provider and Patient
|
| Quantity in
Shipment: |
Varies by product |
| Delivery Time: |
0-1 week
|
| Re-application
Policy: |
Enrollment is on a calendar year basis, with opportunity to re-enroll.
|
| Refill Policy: |
Refills can be requested by calling the Program |
| Other Information: |
Individuals can also apply online, download an application at www.azandme.com. |
|
|
Last Updated: 05/07/2026
www.RxAssist.org
|