Services Provided:

• No cost for your prescription medications
• Medication counseling
• Refill reminders
• Delivery assistance:
  • Mail order delivery
  • Potential delivery of medications to a local clinic

Qualifications for Service:

• You must be a resident of the state of Texas,
• have an annual household income below 300% of the Federal Poverty level for your family’s size,
• have no health insurance, and
• have a valid prescription for your medication.

To Apply:

• Fill out the application. (Type your answers into the fillable PDF, then save the document to your computer. You may also download and print the application to complete it by hand.)
•  Gather all your documentation:
  • Proof of residence
  • Proof of income (If you have no income, or someone helps to support you, you can submit the Hardship Referral Letter to meet the proof of income requirement.
  • Photo ID
  • Prescription

All applications and documentation must be scanned and emailed to [email protected] or faxed to 469-687-9126

Free