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For Healthcare Providers
If your patient is having trouble affording an AstraZeneca medication, AZ&Me may be able to help.
Helping your patient apply to AZ&Me
If the patient or legally authorized representative (LAR) is physically present to provide consent, you can apply online.
If a patient or LAR is not present in the office, they can fill out and fax the application or you may direct them to apply online at www.azandme.com.
Before starting the application and requesting to enroll a patient in the program, make sure you have the following:
- The name and formulation of the AstraZeneca medication prescribed to the patient
- The patient’s contact, health insurance, and income information
For more information on what you need before getting started and what to expect after submitting the application, please see Applying to the Program. You will be notified whether or not your patient is eligible.
Manage existing patients
For enrolled patients, you can:
- Track key actions such as your patient’s enrollment status, refill status, and appeal status (if their enrollment request was denied) within your profile
- Manage the medications of multiple patients within your profile
Sending prescriptions
For patients that are successfully enrolled into the AZ&Me program, a new prescription is needed for the enrolled medication. Prescribers can submit the prescription directly to our pharmacy via one of the following methods:
- Submit an e-Prescription to the pharmacy. Instructions here
- Send a prescription to AZ&Me via fax (1-877-239-0867)
To ensure timely processing, please make sure that the patient’s name on the prescription matches exactly what was on their AZ&Me application.
Forms
Cold Chain Products: Shipment Request Form
for a form description
For HCPs to request the next refill for a cold chain product
Program Consent Form
for a form description
For patients and their Legally Authorized Representatives (LARs) to provide program consent needed to facilitate the application/enrollment process
Specialty/Rare: Insurance Reconsideration Form
for a form description
For Specialty and Rare Disease HCPs to request a re-evaluation of a Specialty and Rare Disease patient's eligibility when the patient has been denied due to their insurance status. Must be signed by the prescriber and submitted with supporting documentation
Specialty/Rare: Medicare Enrollment Form
for a form description
For new and re-enrolling Specialty and Rare Disease Medicare patients, Legally Authorized Representatives (LARs), and HCPs when providing required documentation to finalize the patient's Conditionally Approved enrollment. The form is required and must be submitted with applicable supporting documentation
Withdrawal Form
for a form description
For patients, Legally Authorized Representatives (LARs), and HCPs to discontinue a patient's enrollment when AZ&Me support is no longer needed
Healthcare Providers User Guide
This user guide is for Healthcare Providers (HCPs) using the AZ&Me website. It offers clear, step-by-step instructions for registering, signing in, navigating Patient lists and dashboards, sorting and filtering Patients, and performing actions to support each Patient’s application.
How-To Videos
Home Page Overview
Information on the navigation bar and where to find resources for both Patients and Healthcare Providers.
Healthcare Provider Registration/Sign In
Learn how HCPs can register and sign in to the AZ&Me website.
Healthcare Provider Applying to AZ&Me
Learn how HCPs can apply to AZ&Me online.
Healthcare Provider Patient List
Learn how HCPs can sort and filter their Patient List and locate actions needed on the Patient dashboard.
Healthcare Provider Document Upload
Learn how HCPs can upload documents to the AZ&Me Website for a specific Patient.
Healthcare Provider Refill Management
Learn how HCPs can manage refills for their patients.
Home Page Overview
Information on the navigation bar and where to find resources for both Patients and Healthcare Providers.
Healthcare Provider Applying to AZ&Me
Learn how HCPs can apply to AZ&Me online.
Healthcare Provider Document Upload
Learn how HCPs can upload documents to the AZ&Me Website for a specific Patient.
Healthcare Provider Registration/Sign In
Learn how HCPs can register and sign in to the AZ&Me website.
Healthcare Provider Patient List
Learn how HCPs can sort and filter their Patient List and locate actions needed on the Patient dashboard.
Healthcare Provider Refill Management
Learn how HCPs can manage refills for their patients.
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