We pre-fill your application, write your doctor letter, prepare your fax cover sheet, and tell you exactly which income documents to gather.
Your personal info, insurance, and medication details already entered
Professional letter telling your doctor exactly what to sign and where to fax
Fax cover sheet, income document checklist, and step-by-step timeline
Your information stays in your browser. Nothing is sent to our servers. The PDF is generated entirely on your device.
Patient Assistance Programs are manufacturer-sponsored programs that provide free or low-cost brand-name medications to people who cannot afford them. Nearly every major pharmaceutical company offers a PAP for their expensive medications. Income limits typically range from 250% to 500% of the Federal Poverty Level, which means individuals earning up to $90,000/year may qualify for some programs.
Select your medication from the dropdown, enter your basic information, and we generate a complete 6-page PDF application packet. Everything is pre-filled with your data. You print it, sign the patient section, hand the doctor letter to your prescriber, and fax or mail everything together. The entire process happens in your browser — your data never leaves your device.
We currently support application generation for BMS Patient Assistance Foundation (Eliquis), NovoCare PAP (Ozempic, Wegovy, Rybelsus), and myAbbVie Assist (Humira, Rinvoq, Skyrizi). More programs are added regularly. For any drug with a PAP, you can use our general application generator which works with any manufacturer program.