How to Enroll

Please download and fill out our enrollment form and mail to PSA, PO Box 7777, Fort Worth, TX 76111 or fax to 817-804-1800. For some general qualification guidelines, please see below.

Please contact us at 866-804-0565 Monday-Friday 8:30 to 4:30 and one
of our specialists will be happy to assist you.

Do I Qualify?

Each pharmaceutical company has its own criteria for qualification to receive assistance. In general, the patient must:

• Be a United States resident.
• Not covered by insurance for outpatient prescription drugs.
• Not qualify for a government program (such as Medicaid) or a third-party program that provides for prescription medication.
• Not enrolled in MEDICARE PART D (Prescription benefit starts Jan. 1, 2006).
• Have an income level that would result in hardship if required to purchase medications at retail price.

The applicant's income must fall within the limits established by each individual program sponsor. The household income limits vary from program to program. Patients who currently receive assistance have incomes ranging from below national poverty level to as much as $50,000 per year. Those qualifying at the highest income levels generally include cases such as cancer, AIDS, or transplant patients who require high-cost medications. Typical qualifiers have income below $18,000 per year for an individual and $30,000 per year for a couple. The various program sponsors make all decisions about which drugs to be included in the programs and which individuals will receive assistance, not PSA.