How to apply to the AZ&Me™ Prescription Savings Program
There are three easy ways to apply. You can:
- Enroll by phone > Call 1-800-AZandMe (292-6363)
- Enroll by mail > Download and complete the application (PDF 641kb)
AZ&Me Prescription Savings Program
PO Box 898
Somerville, NJ 08876
- Enroll by fax > Download and complete the application (PDF 641kb)
and have your doctor's office
NOTE: Faxed applications MUST be sent from your doctor’s office in order for your prescription to be processed.
You will also need the following:
- Financial documentation (acceptable forms include):
- A copy of last year's federal income tax returns for yourself, your spouse, and dependents
- All income statements from jobs (W2 or 1099)
- Social Security Income Yearly Benefits Statement
- Your prescription(s) for the AstraZeneca medicine(s) you are taking
- If you are a US citizen, you will need to provide your Social Security Number
- If you are not a US citizen, you must provide one of the following:
- Green Card number
- Work Visa Number
If you are experiencing a recent financial hardship, you will need to include supporting documentation explaining change in circumstance and new income. Such as:
- Change in household income (letter from employer)
- Change in marital status (legal record supporting change)
- Change in household size (copy of birth or death certificate)
If you have any questions about the application process, or to learn more about whether or not you or someone you know may qualify for this program, call 1-800-AZandMe (292-6363), Monday through Friday, 8:00 AM-6:00 PM ET.
Some of our online services are currently unavailable
The following web-based self-service tools on our site are temporarily unavailable: web-based application, refill request, enrollment status and order tracking services. We apologize for any inconvenience this may cause.
- To request a prescription refill, check enrollment status or check that status of an order, please call 1-800-AZandMe (292-6363).
- We are in the process of making improvements to our site, and will be making these services available again later in 2013.
- As we continue to make changes and improvements, www.AZandMe.com remains available as a source of information on the AZ&Me Prescription Savings Program.
2639002 Last Updated 5/13