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Welcome to the Application Forms Center

Whether or not you have used BenefitsCheckUpRx™ to find prescription drug savings programs and other valuable federal and state programs you may qualify for, you can use ABC's Application Forms Center to easily access Application Forms and Fact Sheets for over 250 prescription assistance programs, including state pharmacy programs, patient assistance programs and Medicare-approved discount drug cards. In addition, you will also find Application Forms from your State’s Medicaid and Medicare Savings Programs.

There are four easy ways you can search for Application Forms:

  • by drug (you may select the brand name or generic name);
  • by application form category;
  • by state; and
  • by application form date.

Most Application Forms can be viewed here, printed out and filled out by hand. In most cases, you will have to mail them in an envelope to the address found on the form or the Fact Sheet. A few forms are fillable online - meaning you can fill them out while on your computer and print them.

Click here to view the hundreds of prescription savings options and other valuable federal and state programs the Application Forms Center has available for you.

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  Public Policy Report
The Next Steps: Strategies for Improving the Medicare Part D Low-Income Subsidy

Executive Summary
Full Report
 
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  Applying for the Low-Income Subsidy: A Tool Kit for Advocates (Developed by the Access to Benefits Coalition)

Click Here to access Tool Kit contents
 
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  A Report to the Nation from the Access to Benefits Coalition

Pathways to Success: Meeting the Challenge of Enrolling Medicare Beneficiaries with Limited Incomes

Executive Summary
Full Report
 
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