Immediate Medication Assistance

Immediate Medication Assistance

Cancer drugs can be expensive – even with insurance. But they also can improve a patient’s outcome and quality of life. That’s why it’s important to fill prescriptions and take them, and other non-prescription medications, exactly as prescribed.

What’s Immediate Assistance?

If a patient isn’t able to cover the cost to fill a prescription, even for a brief period until reimbursed, apply for immediate medication assistance to avoid delays in the start of prescribed treatment. With this partnership for medication assistance, The APG Foundation makes a pharmacy payment directly to participating pharmacies on the patient’s behalf.

Participating Pharmacies

Choose from our participating Cedar Rapids pharmacy partners:

How to Get Rx Help

To apply for immediate assistance, follow these steps:

  1. Patient -- Download this form Immediate Medication Assistance Application.
  2. Patient -- Complete the "Patient Information and Authorization:" section of the form.
  3. Physician's Office -- Complete the "Ordering Physician:" section of the form.
  4. Physician's Office -- Send prescription(s) to the selected pharmacy.
  5. Patient -- Take the completed Immediate Medication Assistance Application to the selected pharmacy (The pharmacy sends the bill directly to The APG Foundation.)
  6. Patient -- Complete the application below so APG Foundation has patient's contact information.
  7. Patient -- Pick up medication at the selected pharmacy.

    Applicant

    Physician Information:

    Consent & Authorization

    By submitting this form:

    • I attest that to the best of my knowledge the information provided is accurate.
    • I affirm that I have no other readily available means to purchase prescribed medications and prostheses.
    • By submitting your information electronically you acknowledge that you may have submitted protected health information (PHI). Please be aware that email communication can be intercepted in transmission or misdirected.
    • I understand that information provide here will only be used by the APG Foundation for processing financial assistance requests and will not be provided outside the APG Foundation.
    • I agree to provide further information if needed.