Patient Online Application Portal

Patient Online Application Portal

Welcome to the Patient Advocate Foundation’s Co-Pay Relief Program (CPR) secured, on-line patient application portal.   Patient Advocate Foundation’s (PAF) Co-Pay Relief Program (CPR) provides financial assistance to financially and medically qualified patients, including those insured through federally administered health plans such as Medicare,  for co-payments, co-insurance and deductibles required by a patient’s insurer for pharmaceutical treatments and/or prescription medications prescribed to treat and/or manage his/her disease. 
 
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. All applications for assistance submitted via a CPR portal or completed over the phone with a program specialist receive an instant eligibility decision at the time of submission based on the information supplied and availability of funding.  Eligibility decisions are made using the patient’s reported income, diagnosis and insurance coverage information.  Patients who are approved for assistance can begin submitting claims immediately.
 
For your convenience the Patient Online Application Portal is available 24 hours, and you may submit your application through this secure website once you have fully completed the application, including all required fields of data, you will be notified immediately if you are eligible for assistance from CPR.  If you are eligible for assistance, your application will be instantly approved and you will have immediate program access.  This application process should take approximately 7-10 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.