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Are You Eligible?

In order to make this process as smooth as possible, make sure that you have everything you need before you begin the pre-screening process, including:

  • the name(s) of your AstraZeneca medication(s)
  • information about whether you have prescription drug coverage
  • information about your total household income

Once you do, please click the role below that fits you best.


Yes No
Select Number
$ monthly or
$ yearly

Based on the information that you've entered, you may qualify for one of our programs.

Please continue the application process by downloading an application that you can mail or have your doctor's office fax it to us. You can also call us and we'll be happy to help you continue the application process.

Call Us

1-800-AZandMe (1-800-292-6363)
9:00 am - 6:00 pm EST

Mail or Fax

AZ&Me Prescription Savings Program
PO Box 222178
Charlotte, NC 28222



*NOTE: Faxed applications MUST be sent from your doctor's office for us to process your prescription.

Download an Application

Pre-screening Results

We're sorry, but based on the information that you've entered, it appears that you are not eligible to enroll in the AZ&Me Prescription Savings Program. Please see our eligibility requirements if you have questions about these results.

Even though your patient doesn't appear to qualify, you may want to continue the application process on their behalf or re-enter the information in the pre-screening process and try again.