To get started, you can download and print an application.
You may also start the application process by calling CareASSIST at 1‑833‑WE+CARE (1‑833‑930‑2273), Mon-Fri, 9 AM – 8 PM ET. A Patient Access Specialist will assist you with the next steps.
Patients may provide certain information and a signature, but a licensed healthcare provider authorized to prescribe, dispense, and administer medication in the US must fill out and sign the application. Once completed, you may submit applications by mail or fax (1‑855‑411‑9689).