Pharmacy Online Application Portal

Pharmacy Online Application Portal

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

To insure the continued integrity of the program, all patients approved for assistance are required to have a physician verify his/her diagnosis by completing and signing a Physician Verification Form and submitting it to the CPR program within 30 days of the patient’s approval date.

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 Pharmacy Center click New Pharmacy 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.