Patient Online Application Portal

Patient Online Application Portal

Welcome to the Patient Advocate Foundation Co-Pay Relief Program (CPR) secured, on-line application portal.   In effort to better serve our patients, while also meeting the growing demands of our program, the CPR is pleased to offer a patient application portal.

The CPR Program currently provides direct financial support to insured patients, who are financially and medically qualified, for pharmaceutical treatments and/or prescription medication co-payments, co-insurance and deductibles relative to your diagnosis.  

Additionally, our program provides assistance to patients on a first come first serve basis and processes applicants in the order in which their completed applications are received.  Please be advised that only one application per patient will be accepted and a thorough review of the completed application packet, in its entirety, is necessary before a final determination of acceptance can be made.  

For your convenience the Patient Online Application Portal is available 24 hours, and you may submit your application through this secure website which will provide you with expedited program access.  This application process should take approximately 5 minutes to complete.

Quick reference guides are available to download or print for detailed instructions on the following:

 

If you would like to begin the application process and this is your first time visiting the Patient Online Application Portal, click Patient Registration below to create an account. To check on the status of a previously submitted application click the appropriate link below.

Please Note:  A valid email address is required to complete the registration process.  After registering, you will receive an email to confirm your registration and create your password.  Your account will not be active until you have confirmed your registration and created your password.  Once this is done, you can log in any time with your email address and password.