The RxCopay website offers a dedicated and secured web-based application portal for interested applicants to enroll electronically. We have made these portals to provide you with expedited program access for your convenience. The portals are available 24 hours.
Our program aids applicants on a first-come first-serve basis. Applicants are processed in the order in which their complete applications are received. Please understand that a thorough and comprehensive review of the completed application packet, in its entirety is appropriate before a final determination of acceptance for assistance can be made.
The application process requires a valid email address.
Only one application per patient will be accepted, please be guided.
To be sure your application packet is complete, please have all information and materials listed on the application checklist prepared and accessible.
Application Checklist
- Proof of your identity
- Proof of your residence
- Proof of your social security number
- Name, address, phone numbers
- Birth Certificate
- Name of healthcare provider and insurance.