How to enroll

(Last Updated On: February 11, 2022)

To get started with Prescription Hope, you can enroll online.

First, you will need to create an account.

Second, you will need to complete and submit your enrollment form. To complete your enrollment form, you will need the following information on hand.

If you have all your information available, it should only take about 5-10 minutes to complete your enrollment form. Here’s some info you will want to gather before you get started.

Creating your account

To create your account with Prescription Hope, you will need:

  1. The patients first name, middle initial, and last name
  2. A valid email address
  3. Mobile phone number
  4. Create a password for yourself

Create Account with Prescription Hope

Creating an account will allow you to save the enrollment form where you left off if you cannot complete it, check your enrollment status, and update any information throughout your enrollment.

If you have already created your account, you can log in here.

Patients mailing address

Prescription Hope will mail a welcome packet and other important information to you throughout your enrollment. The pharmaceutical manufacturers that ship your medication may deliver your medication to this mailing address.

  1. Street address
  2. Apartment, suite, unit, etc.
  3. City
  4. State
  5. ZIP Code

Patient Mailing Address

Please Note: Some medications will get delivered to your healthcare provider’s office.

Patient information

The pharmaceutical manufacturers require all the information requested to process your medication orders. All of your information will be kept confidential and protected:

  1. Is the enrollment form on behalf of a minor?
    1. If yes, then we will collect parent/guardian name and information.
  2. Gender
  3. Date of birth
  4. Social security number
  5. Alternate contact (optional) – Click here for instructions on how to enroll a loved one
  6. How did you hear about Prescription Hope?

Patient Information

Monthly household income information

To successfully enroll in patient assistance programs, the patient has to qualify based on different income guidelines for each medication.

If the patient currently has income, you will need the following information on hand for the patient:

  1. Current employment status
  2. Current marital status
  3. How many people live in the household
  4. Yes or no questions
    1. Does the patient file tax returns?
    2. Is the patient a US Citizen?
    3. Has the patient applied for Medicaid?
    4. Is the patient on Medicare?
    5. Is the patient disabled as determined by Social Security
  5. The patient’s current monthly income

Monthly Household Income

Healthcare provider information

Prescription Hope will contact your healthcare provider(s) to request prescriptions for the medications we enroll in patient assistance programs. To contact your healthcare provider, we will need the following information:

  1. The healthcare provider’s name
  2. Facility name
  3. Address
  4. Phone number
  5. Fax number

Healthcare Provider Information

You can add one or multiple healthcare providers by searching our list or add them manually. Please, only list the healthcare provider(s) prescribing medication you are requesting through Prescription Hope. If this information is not correct, the first medication delivery will get delayed.

Medication list

Here you will list each medication you are paying more than $60.00 a month to receive. You will need to enter the following information for each medication.

  1. Medication name
  2. Medication strength
  3. Medication frequency
  4. Attached the correct prescribing healthcare provider

Medication Information

If you don’t have all the medications on hand, don’t worry. You can always add medications to your account at any time.

Payment method

When you enroll, Prescription Hope asks for a payment method to cover your service fee for each medication you add. The only charge you will receive is $60.00 a month for each medication added. We do not charge any other fees, copays, or deductibles. You will need to enter the following information to complete your payment method.

  1. Card number
  2. Expiration date
  3. CVC (The 3 digit security code on the back, or 4 digit code on the front for American Express)
  4. Accept our terms of service

Payment method for Prescription Hope

To verify your account, we’ll run a $0.01 verification charge, which will get refunded within 24 hours. You can expect your first charge between 24-48 hours after enrolling when Prescription Hope pre-qualifies you to receive your medication. If you are not pre-qualified, we will not charge you the monthly service fee.

Frequently Asked Questions

Why do you need my social security number on the enrollment form?

The pharmaceutical manufacturers that provide the medication require the patient’s social security number to process medication orders for their patient assistance programs. Information related to electronic transactions entered into this website will be protected by 256-bit encryption technology.

Can you contact me to fill out the enrollment form?

Prescription Hope does not offer a service to fill out our enrollment form at this time. Our enrollment form is the most effortless way to collect the necessary information for prequalification to see if we can enroll you into the correct patient assistance program.

Do I have to stay in the program for a year?

Prescription Hope works on a 12-month agreement, enrolling and managing individuals into patient assistance programs for one year.  You can cancel your account at any time with a 30-day written notice. We will then stop charging your payment method on file and stop all future refills from the patient assistance program you are enrolled in. Prescription Hope’s service works best for individuals looking for relief from high-priced medications they will take for long periods.

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