How to Apply Online

The Co-Pay Relief Program (CPR) offers a dedicated, secured web-based application portal for patients, providers and pharmacies to enroll electronically. We have created these portals to provide you with expedited program access, and for your convenience the portals are available 24 hours per day. If this is your first time utilizing the online portals and you wish to access this resource, please click the appropriate Online Services link within the For Patients, For Providers or For Pharmacies section to register.

Our program provides assistance to patients on a first-come, first-served basis and processes applicants in the order in which their completed applications are received. Please understand that a thorough review of the completed application packet, in its entirety, is necessary before a final determination of acceptance for assistance can be made.

For Patients

The registration process will only take approximately 2-3 minutes! Note: The registration process requires a valid email address. Once the registration is complete you will receive an email to confirm your registration and create your password. You may immediately begin the enrollment process which should take approximately 5 minutes. Please be advised that only one application per patient will be accepted. Click the button labeled Online Services for Patients to continue to register and apply to the CPR program. We look forward to serving as a resource for your pharmaceutical co-payment needs!

Online Services for Patients

For Providers

The registration process will only take approximately 2-3 minutes! Note: The registration process requires a valid email address, provider’s Tax Identification Number (EIN) and National Provider Identifier (NPI). Once the registration is complete you will receive an email to confirm your registration and create your password. You may immediately begin the patient enrollment process which should take approximately 5 minutes. Please be advised that only one application per patient will be accepted. Click the button labeled Online Services for Providers to continue to register and apply to the CPR program on behalf of your patients. We look forward to serving as a resource for your patients' pharmaceutical co-payment needs!

Online Services for Providers

For Pharmacies

The registration process will only take approximately 2-3 minutes! Note: The registration process requires a valid email address, provider’s Tax Identification Number (EIN) and National Provider Identifier (NPI). Once the registration is complete you will receive an email to confirm your registration and create your password. You may immediately begin the patient enrollment process which should take approximately 5 minutes. Please be advised that only one application per patient will be accepted. Click the button labeled Online Services for Pharmacies to continue to register and apply to the CPR program on behalf of your patients. We look forward to serving as a resource for your patients' pharmaceutical co-payment needs!

Online Services for Pharmacies