- If you earn $30,000 or less per year as a single person or $50,000 or less as a couple. These are average figures; some pharmaceutical company's guidelines may be higher.
- You may have a discount prescription drug card and still qualify.
- Do not participate in Medicaid.
- You are experiencing financial hardship.
![]() |
![]() |
![]() |
This application requires Adobe Reader. If you do not have it installed, download it here.
How the Program Works
- Prospective patients can pre-enroll by calling Prescription Hope, Inc. toll free 1-877-296-Hope (4673) to receive an application packet, or download an application at www.prescriptionhope.com.
- In less than 24 hours an enrollment counselor with Prescription Hope, Inc. will match your prescriptions using our state of the art software system with the correct pharmaceutical companies, and begin the process of completing all applications on behalf of the patient and doctor.
- Prescription Hope, Inc. will work closely with your doctor's office to have their applications completed efficiently and in a timely manner.
- After we receive your completed applications from the doctor's office, we will check them for completeness and accuracy, attach all necessary documents and forward them to the pharmaceutical companies for their approval.
- Once the pharmaceutical company receives your application, it normally takes 1 to 3 weeks to receive your medications.
- For your convenience most of your medication will be shipped in a 3 month supply to your home or your doctor's office.
- Prescription Hope, Inc. will track your prescriptions and automatically re-fill with the pharmaceutical companies to ensure continual prescription medication coverage as easy and hassle free as possible.





