Provider Online Application Portal

Provider Online Application Portal

Welcome to the Patient Advocate Foundation's Co-Pay Relief Program’s (CPR) secured, on-line provider 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 Provider Online Application Portal is available 24/7, and you may submit applications behalf of patients you are serving through this secure website.

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.