PharmaciesA prescription for peace of mind

At times, when the medication costs more than patients can afford, patients may feel a since of hopelessness. The Patient Advocate Foundation Co-Pay Relief Program can help by covering co-payments, co-insurance and deductibles required by a patient’s insurer for medications prescribed to treat and/or manage their disease.


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Our tool allows you to quickly search for certain account information without having to log into your portal account or calling into the program.

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What can we help with?

PAF’s Co-Pay Relief (CPR) program provides direct financial assistance to qualified patients with co-payments, co- insurance or cost-sharing associated with prescription drugs through funds dedicated to specific disease states. In some instances, assistance with insurance premiums and/or ancillary services associated with the disease also may be available.

Required Information to Complete an Application for Assistance:

  • Patient Demographic Information
  • Annual Household Income
  • Authorized person – if anyone else is authorized to speak with CPR on behalf of the patient include their name, relationship and phone number
  • Insurance Information
  • Treating Physician Information – Facility Name, Address, Phone and Fax Number
  • Medical Diagnosis
  • Confirmation you have a treatment plan and are currently in treatment, have been in treatment in the last 6 months or will begin treatment in the next 60 days

Submitting Documents: What are the options?

CPR accepts documents via Virtual Pharmacy Card, electronic upload, fax or by mail

For applications submitted through our website, supporting documents may be uploaded electronically

  • Please allow 24 to 48 hours for uploaded documents to reflect on the online portal.

Applications and supporting documents may be faxed

  • Please use the unique bar-coded fax coversheet when faxing information to CPR.
  • Please note that each application submission has a unique bar code and the applications are not interchangeable.

Mail application and supporting documents

Program Contact Information:
Web Portals:
Phone Number 866-512-3861 Fax Number: 757-952-0119
Address: Patient Advocate Foundation Co-Pay Relief Program; 421 Butler Farm Road, Hampton, VA 23666

My Patient is Approved, What Now?

  • Patients approved for assistance are required to have their verified diagnosis and treatment plan along with supporting documentation completed and returned within 30 days of approval to ensure continuation of the award.
  • As an alternative to submitting the Physician Form, an authorized pharmacy representative can report and verify the patient’s diagnosis and treatment plan. Documentation from the from the pharmacy that confirms the diagnosis and treatment for the patient, as provided by the prescriber to the pharmacy must be submitted to the program for review.
  • Approved patients who do not submit a completed form verifying their diagnosis and treatment within 30 days from approval will forfeit their award.
  • Patients who forfeit their award due to not submitting documentation to verify their diagnosis and treatment are not eligible to reapply for the program until 12 months from the original date of approval.
  • If the patient is requested to provide documentation of their reported income, please submit the documentation to the program within 30 days of the application date to ensure continuation of the award.
  • If the requested income documents are not received within 30 days from the date the application was initiated, the award will be forfeited, and you will not be eligible to reapply to the program until 12 months from the original date of the application.
  • Income documents can be uploaded to the online portal or faxed to us using the unique bar-coded fax cover sheet.
  • Once approved, begin using your award immediately! Please submit your claims via Virtual Pharmacy Card, uploading them to the online portal or faxed to us using the unique bar-coded fax cover sheet.


How do my patients qualify?
  • Must be currently insured and have coverage for medication seeking financial assistance
  • Have a confirmed diagnosis and treatment plan
  • Must reside and receive treatment in the United States
  • Income must fall at or below 300% or 400% of the Federal Poverty Guideline (FPG) with consideration for the Cost of Living Index (COLI) and number in the household
  • Applications can also be completed by contacting us toll free at 866-512-3861, to be connected to a CPR Specialist

Welcome to the Co-Pay Relief program!

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