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Apply for prescription assistance.

Download the Application

Prescription Assistance

Every major pharmaceutical company has a patient assistance program that provides free prescription medications to eligible patients. If you're uninsured or under-insured our Prescription Assistance Program can help determine your eligibility and guide you through the application process.

How to Get a Prescription Assistance Application

  • Download, print and mail, or hand-deliver, a completed prescription assistance application to Concord Hospital Prescription Assistance, 250 Pleasant Street, Concord, NH 03301
  • Ask your healthcare provider for an application or ask him/her to contact the Prescription Assistance Program on your behalf
  • Call the Prescription Assistance Program at (603) 227-7009, Monday - Thursday between 8 am and 4 pm
  • Visit the program office at Concord Hospital, 250 Pleasant Street, Concord, NH 03301

Frequently Asked Questions

Is it okay if I own my own home?

Yes. The pharmaceutical companies do not look at your residence.

How much will I have to pay for my medications?

The pharmaceutical companies provide the medications free of charge.

Is this an insurance policy/coverage?

No. This program simply takes advantage of patient assistance programs set up by the pharmaceutical companies.

Who is paying for the medications?

Each individual pharmaceutical company supplies the medications they produce to patients in need at no cost. The pharmaceutical companies are absorbing the costs of the medications.

Who decides if I am eligible for the program?

Each individual pharmaceutical company has the ultimate decision who is eligible to receive their medications.

Can I get more than one 3-month supply of each medication?

Yes. Most companies allow you to reapply every 3-months for as long as they meet the eligibility requirements.

How does it work?

We will complete one application for each medication that you're currently taking. The application needs to be signed by you and your physician. The applications are then sent to pharmaceutical companies. Once the application had been reviewed and approved, the medication will be shipped out. In most cases, the medication is sent to your physician’s office. A few companies send the medications directly to your home.

How long does it take to get my medications?

You should plan on 4-6 weeks from the time the applications are mailed to when you receive your medications. Make sure you have enough medication to hold you over until then.

Requirements

  • You must be a United States resident
  • You must meet the eligibility criteria established by the pharmaceutical companies
  • You must be taking a long-term medication. (As part of the application process, you will be asked to provide a list of your medications and proof of income.)

You must live in, or see a physician in, one of the following towns:

Allenstown
Alton
Andover
Antrim
Auburn
Barnstead
Belmont
Bennington
Boscawen
Bow
Bradford
Bristol
Candia
Canterbury
Center Harbor
Chichester
Concord
Contoocook
Danbury
Deerfield
Deering
Dunbarton
Epsom
Francestown
FranklinGilford
Gilmanton
Goffstown
Henniker
Hill
Hillsboro
Hooksett
Hopkinton
Laconia
Loudon
Meredith
New Boston
New Hampton
New London
Newbury
Northfield
Northwood
Pembroke
Penacook
Pittsfield
Salisbury
Sanbornton
Suncook
Sutton
Tilton
Warner
Washington
Weare
Webster
Wilmont
Windsor