Provider Online Application Portal

Provider Online Application Portal

Welcome to the Patient Advocate Foundation's Co-Pay Relief Program’s (CPR) secured, on-line application portal. In an effort to better serve you and your patients, while also meeting the growing demands of our program, the CPR is pleased to offer a provider 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 Provider Online Application Portal is available 24 hours and you may submit applications through this secure web-site on behalf of your patients. We have created this site to provide you with expedient 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 for your patient and this is your first time visiting the Co-Pay Relief Provider Center click New Provider Registration link below to create an account. If you have previously registered and would like to begin an application or view previous submitted patient(s) click the appropriate link below.

Please Note:  The provider's Tax Id, NPI number, and a valid email address are required to complete the registration process. After registering, you will receive an email to confirm your registration and create your password. Note: Your account will not be active until you have confirmed your registration and created your password. We encourage you to confirm your registration as soon as you receive your e-mail. Once this is completed, you will be able to log in any time with your email address and password.