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Co-Pay Relief Program


* Operating as an independent division within PAF, this program provides direct financial assistance with co-payments, co-insurance and deductibles required by your insurer for pharmaceutical treatments and/or prescription medications relative to your diagnosis.

Eligibility: Patient must be currently insured and have coverage for the medication(s) for which they seek financial assistance.
Patient must have a physician confirmed diagnosis of the disease under which they are requesting financial assistance. See website ( for up to date list.
Patient must reside and receive treatment in the United States.
Patient's income must fall below the income guidelines of the fund under which they are requesting financial assistance. All funds have income guidelines of either 300% or 400% or less of the Federal Poverty Guideline (FPG) with consideration for the Cost of Living Index (COLI) and the number in the household.
Patient will be informed immediately upon application if they qualify for assistance.

Application Process: CPR offers four (4) points of entry into the program accepting applications daily. The program offers online service for patients, providers and pharmacies allowing them to apply electronically through a secured, web-based application portal available 24 hours a day. The program continues to provide personalized assistance through a dedicated professional representative, by phone, who will guide them through the application process and answer any questions you may have.

Required Documentation: In order to make a final eligibility determination on your application, the following information is all that you need: 1. Signed, completed application 2. Physician Form, completed and signed by your treating physician 3. Copy of signed federal tax return from most recent tax year (pages 1 & 2 only) In the rare case that you are unable to provide a federal tax return from most recent year, we can consider alternate documents to verify your income.

Fees: No fee for service.

United States.

Patient Advocate Foundation

The Patient Advocate Foundation (PAF) provides direct financial support for pharmaceutical co-payments to insured patients, including Medicare Part D beneficiaries, who financially and medically qualify.

421 Butler Farm Road
Hampton VA 23666


Hours: M-F 8:30AM-5:00PM


Toll Free:



421 Butler Farm Road
Hampton VA 23666



This program is offered at this site:

Patient Advocate Foundation

Main Address:

421 Butler Farm Road

Hampton VA 23666


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