Apply Now

Start your application. About 15 minutes.

ProvisionRX handles everything after you submit — application preparation, physician coordination, submission, and ongoing management for as long as you're enrolled.

What you'll need — about 15 minutes
Your medication name(s)
Name or description of the medications you need managed
Basic contact information
Name, email address, phone number, and mailing address
General income information
Approximate household income and household size — not exact figures at this stage
Insurance coverage type
Whether you are uninsured, on a high-deductible plan, Medicare, etc.
Prescribing physician nameOptional
Your doctor's name and clinic — helpful but not required to start
Social Security NumberNot required
Not required at the application stage
Your information is used only to prepare your application. Never sold.
30-day money-back guarantee
No SSN required to start
Response within 1 business day
1
Medication
2
Contact Info
3
Eligibility
4
Review

Tell us about your medication

Enter the name of the medication(s) you need help with. Not sure of the exact name? That's fine — just describe it as best you can.

You can list multiple medications separated by commas.

After You Apply

What happens, step by step

Day 1

Application reviewed

We confirm receipt, review your information, and identify applicable manufacturer programs.

Days 2–5

Application prepared

We prepare your complete application package, including income documentation guidance and physician authorization forms.

Days 3–7

Physician coordination

We contact your physician's office to complete the authorization required by the manufacturer program.

Week 2

Submitted to manufacturer

Your completed application is submitted directly to the manufacturer through the correct channel.

Weeks 4–10

Manufacturer review

The manufacturer evaluates your eligibility. We monitor status and follow up proactively if there are delays.

Upon approval

Medication coordinated

We coordinate delivery logistics — whether direct to your home or through your physician's office.

Your Role

Your role vs. ours

You handle

  • Complete the 15-minute application form
  • Provide income documentation when requested
  • Inform us of any address or insurance changes

ProvisionRX handles

  • Research all applicable manufacturer programs
  • Prepare complete application packages
  • Coordinate physician authorization
  • Submit through correct manufacturer channels
  • Monitor status and follow up proactively
  • Coordinate approval and delivery logistics
  • Manage refills and annual reauthorization
ProvisionRX application and paperwork management

30-day guarantee

Full refund if unsatisfied within 30 days.

No SSN required

Social Security Number not needed at this stage.

1 business day

We confirm and begin work within one business day.

Cancel any time

No long-term contracts or cancellation fees.