Immediate Prescription Assistance | Apply Today

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:

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

Applicant

Name: (required)

Street Address: (required)

City: (required)

State: (required)

ZIP: (required)

Telephone: (required)

Email address: (required)

Patient Birth Date (mm-dd-yyyy): (required)

Physician Information:

Physician Name:

Office address:

How did you learn about APG Foundation?

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.

I Agree