The AZ&Me™ Prescription Savings program for people with Medicare Part D is designed to provide AstraZeneca medicines at no cost to qualified patients enrolled in a Medicare Part D prescription drug coverage plan but who are having difficulty affording their AstraZeneca medicine(s).

NOTE: Patients with Medicare Part B coverage may also be eligible. Please call 1-800-AZandMe for more information.

How to Apply

Please either download the application below (if available) or go to the program website for more information on how to apply. Once you fill out your application, send it to the address on the application. Remember not to send program applications to PPA.

Product(s) Covered by Program

  • A

    • ARIMIDEX® (anastrozole) Tablets
  • B

    • BRILINTA® (ticagrelor) 60mg Tablets
    • BRILINTA® (ticagrelor) 90mg Tablets
    • BYETTA® (exenatide) Injection
  • D

    • DALIRESP® (roflumilast) Tablets 500mcg
  • F

    • FARXIGA® (dapagliflozin) Tablets
    • FASLODEX® (fulvestrant) Injection
  • I

    • IMFINZI (durvalumab)
    • Iressa® (gefitnib) tablets 250mg
  • K

    • KOMBIGLYZE® XR (saxagliptin and metformin hydrochloride extended-release) Tablets
  • L

    • LYNPARZA™ (olaparib) Capsules
  • M

    • MERREM® I.V. (meropenem for injection)
    • MOVANTIK™ (naloxegol) Tablets
  • P

    • PULMICORT FLEXHALER® (budesonide inhalation powder, 90 mcg &180 mcg)
  • S

    • SYMBICORT® (budesonide/formoterol fumarate dihydrate) Inhalation Aerosol
    • SYMLIN® (pramlintide acetate) Injection
  • T

    • TAGRISSO™ Tablet
    • TUDORZA® PRESSAIR® (aclidinium bromide inhalation powder) 400mcg
  • X

    • XIGDUO™ XR (dapagliflozin and metformin hydrochloride extended-release) Tablets
  • Z

    • ZOLADEX® (goserelin acetate implant) 10.8 mg 3-month depot
    • ZOLADEX® (goserelin acetate implant) 3.6 mg 1-month depot
    • ZURAMPIC® (lesinurad) Tablets 200 mg