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BenefitsCheckUpRx
Enrollment Center

Welcome to the Coalition Contacts

Whether or not you have used BenefitsCheckUpRx™ 2.0 to find prescription drug savings programs you qualify for, you can use ABC's Enrollment Center.

Here, you can find hundreds of prescription drug savings program enrollment forms. By selecting your state you can view enrollment forms for state pharmacy programs, patient assistance programs and Medicare-approved discount drug cards.

Some of the forms are fillable online - meaning you can fill them out while on your computer and print them. Still others can only be viewed here, printed out and filled out manually. In most cases, you will have to mail them in an envelope to the address on the form.

Location:

Social Security Administration
(for information on applying for the extra help with prescription drug plan costs)
Toll Free: (800) 772-1213
TDD/TTY: (800) 325-0778 TTY

Centers for Medicare & Medicaid Services
(for information on plan enrollment)
Toll Free: (800) 633-4227
TDD/TTY: (877) 486-2048 TTY

                               

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To view or print a complete list of state/coalitions
with contact information click here