How it works:

Our enrollment form launches the CareASSIST journey. You and your doctor will:

  • Mark the type of support you are requesting
  • Provide necessary information such as your diagnosis
  • Provide signatures

One of our Patient Access Specialists will reach out to you by phone to let you know about your coverage

Visit the DocumentASSIST Portal to easily upload missing or incomplete information

After you've submitted your enrollment form, a Patient Access Specialist may call you or your doctor about missing or incomplete information on your enrollment form, such as income information, insurance information, and authorization signatures. Follow these 6 easy steps:

  1. Visit patientsupportnow.org or click the link under "Useful Resources" to be redirected.
  2. Type in the CareASSIST code when prompted: 8554119689.
  3. The code will cue a reCAPTCHA: “I am not a robot.” Click Continue.
  4. Fill in the requested information.
  5. Drag and drop the document(s).
  6. Click submit.

Apply directly to our Copay Program

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