How do I apply for a Together Rx Access^® Card?

You have three quick options. You may apply:

• Online, in just minutes
• Through the mail, by printing out an application and mailing it back to us
• Or over the phone, at 1-800-444-4106

How long does it take to apply?

The application form takes just a few minutes to complete. When you enroll online or over the phone, you can use your member ID number at participating pharmacies within two hours of enrollment, until your card arrives in the mail (in 4 to 6 business days).

What if I need help filling out the application?

If you need assistance filling out the application form, please call us at 1-800-444-4106.

Eligibility

Who’s eligible for a Together Rx Access Card?

Individuals for whom all four of the following statements are true qualify for a Together Rx Access Card:

1.  I am not eligible for Medicare.
2.  I have no prescription drug coverage of any kind.
3.  My household income is equal to or less than:
          $30,000 for a single person
          $40,000 for a family of two
          $50,000 for a family of three
          $60,000 for a family of four
          $70,000 for a family of five
          Families of six or more and residents of
          Alaska and Hawaii should contact the
          Together Rx Access Program at
          1-800-444-4106 or click here to
          determine eligibility.
4.  I am a legal resident of the United States or
      Puerto Rico

Are my kids eligible if I’m eligible? What about my spouse?

Anyone who meets all the eligibility requirements of the Program is qualified for a Together Rx Access Card. Your spouse or children can be added to your card if they’re eligible.  To add someone to your card, call us at 1-800-444-4106.

How can I verify my eligibility?

For additional help with determining your eligibility or that of a family member, as well as for information on additional prescription-savings programs, you may call the Together Rx Access Program at
1-800-444-4106.

What if I’m not eligible for the Together Rx Access Card?

You may qualify for other prescription-savings programs. Visit www.pparx.org for details or call
us at 1-800-444-4106.

Privacy

Will my private information be protected?

Your privacy is important to us. Together Rx Access does not provide or sell information that identifies you to companies outside the Program.