You must be a resident of the United States, have a work visa, or a green card.

You cannot have any prescription drug coverage through any public or private insurance and must not be receiving prescription assistance in any other form.

Your annual income should be at or below:

Single Person $35,000
Family of two $48,000
Family of three $60,000
Family of four $70,000
Family of five $80,000

You may have Medicare Part D and qualify but only if you aren’t eligible or aren’t enrolled in Limited Income Subsidy (LIS) for Medicare Part D.

Astrazeneca includes a statement claiming to help those whose financial documentation may not accurately depict their actual financial situation. The conditions for acceptance are extenuating circumstances that include but are not limited to:

Loss of income, Change in income, loss of or change in prescription drug coverage, marriage, change in household number.

Medications included in the Astrazeneca Patient Assistance Program:

Arimides (anastrozole) tablets 1mg

Brilinta (tricagrelor) tablets 90mg

Bydureion (exenatide extended-release) for injectable suspension 2mg vial

Bydureion (exenatide extended-release) for injectable suspension 2mg pen

Byetta (exenatide) injection 1.2 mL pen, 2.4 mL pen

Crestor (rosuvastating calcium) 5mg 10mg 20mg 40mg

Farxiga (dapagrliflozin) Tablets 5 mg 10 mg

Faslodex (fulvestrant) injection 500 mg (2 x 250mg injections)

Kombiglyze XR (saxagliptin and metformin hydrochloride extended-release) Tablets 5mg/1000mg,               5mg/500mg, 2.5mg/1000mg

Lynparza (olaparib) capsules 50mg

Merrem IV (meropenem for injection) 500mg, 1g

Movantik (naloxegol) talbets 12.5mg, 25mg

Myalept (metreleptin) for injection 11.3mg per vial

Nexium (esomeprazole magnesium) delayed release capsules 20mg, 40mg

Nexium (esomeprazole magnesium) for oral suspension 2.5mg, 5mg, 10mg, 20mg, 40mg

Nexium IV (esomeprazole sodium) for injection 20mg, 40mg

Onglyza (saxagliptin) tablets 2.5mg, 5mg

Pulmicort Flexhaler (budesonide inhalation powder, 90mcg, 180mcg) 90 mcg, 180mcg

Pulmicort Respules (budesonide inhalation suspension) 0.25mg/2ml, 0.5mg/2ml, 1mg/2ml

Seroquel XR (quetiapine fumarate) extended release tablets 50mg, 150mg, 200mg, 300mg 400mg

Symbicort (budesonide/formoterol fumarate dehydrate) Inhalation Aerosol 80/4.5mcg, 160/4.5mcg

Symlin (pramlintide acetate) injection 1.5mL, 2.7mL

Xigduo XR (dapagliflozin and metformin hydrochloride extended-release) tablets 5mg/500mg, 5mg/1000mg, 10mg/500mg, 10mg/1000mg

Zoladex (goserelin acetate implant) 3.6mg 1-month Depot

Zoladex (goserelin acetate implant) 10.8 mg 2-month Depot

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