Helping patients
access their
AstraZeneca medicines

Are you currently taking any AstraZeneca medications and having trouble affording them? If you are, we may be able to help. This site will guide you through the AZ&Me application process to see if you are eligible for the program.

Get Started

Fax Your Application from
your Doctor’s Office:

For BRILINTA® (ticagrelor):

For SYNAGIS® (palivizumab), or IMFINZI® (durvalumab):

For FASLODEX® (fulvestrant), IRESSA® (gefitinib), LYNPARZA® (olaparib), or TAGRISSO® (osimertinib):

For all other products:

NOTE: Faxed applications MUST be sent from your doctor’s office in order for us to process your prescription.

3 Ways to Apply

Call Us

1-800-AZandMe (1-800-292-6363)

Mail Your Application

AZ&Me Prescription Savings Program
PO Box 898
Somerville, NJ 08876

Begin the Pre-Screening Process

Our programs offer to provide you with AstraZeneca medications at no cost, but we need to determine if you are eligible first.

Learn About Eligibility Learn about eligibility

Helpful Resources & Downloads

Find answers to your questions and downloadable resources that help you prepare and apply for our programs.

View Resources View Resources

Download an Application

You can choose to download a blank application and then fill out the form, or fill your information directly into the PDF before downloading.

Descargar solicitud en español en blanco

If you are seeking assistance for SYNAGIS® (palivizumab),
click here to download an application.