Printable application
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Eligible individuals meet all three of the following requirements: 1. I am not eligible for Medicare.
2. I have no prescription drug coverage of any kind.
3. My household income is equal to or less than:
- $45,000 for a single person
- $60,000 for a family of two
- $75,000 for a family of three
- $90,000 for a family of four
- $105,000 for a family of five
Families of six or more and
residents of Alaska and Hawaii
should contact Together Rx
Access at 1-800-444-4106. |
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You may qualify for other prescription savings. Visit pparx.org for details.
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