To get started, you can download and print an application.
If you do not have access to a computer and printer, you may start the application process by calling CareASSIST at 1-833-WE+CARE (1-833-930-2273), Mon-Fri, 9 AM – 8 PM ET. A CareASSIST Patient Access Specialist will assist you with the next steps.
Your healthcare provider must also fill out and sign portions of your application form. Once completed, your healthcare provider must submit the application by mail or fax (1-855-411-9689).