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Prescription Assistance Program

Download the application form.

Hands holding pill bottleEvery major pharmaceutical company has a patient assistance program that provides free prescription medications to eligible patients. Our Prescription Assistance Program helps eligible uninsured and under-insured patients of all ages apply for these medications.

There are a few ways you can obtain an application:

  • Download, print and mail, or hand-deliver, a completed prescription assistance application form to 246 Pleasant Street, Memorial Medical Office Building, Suite 220, 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) 227-7008 or (603) 227-7009, weekdays between 8 am and 3:30 pm.
  • Visit the program office at 246 Pleasant Street, Memorial Medical Office Building, Suite 220, 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 majority of companies provide the medications free of charge. However, there are a few companies that charge a dispensing fee to pick up the medication at the pharmacy.

It sounds too good to be true. Does it really work?

Yes. Over 12,000 patients across the state of NH are currently receiving their medication through programs like these.

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 products. The eligibility guidelines provided by the Prescription Assistance Program are simply guidelines to follow that closely match the majority of the companies.

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

Yes. Most companies allow patients 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 are currently taking. The application needs to be signed by you and your physician. The applications are then sent to the 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 house and a few companies allow you to pick up the medications at the pharmacy.

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.

Eligibility

Requirements

  • The patient must be a United States resident;
  • The patient must meet the eligibility criteria established by the pharmaceutical companies
  • The patient 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.)

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

Allenstown
Andover
Antrim
Barnstead
Bennington
Boscawen
Bow
Bradford
Canterbury
Chichester
Concord
Contoocook
Deering
Dunbarton
Epsom
Franklin
Henniker
Hillsboro
Hopkinton
Loudon
Northwood
Pembroke
Penacook
Pittsfield
Salisbury
Suncook
Warner
Washington
Weare
Webster
Windsor