Breztri Aerosphere

Indicated For

chronic obstructive pulmonary disease, COPD

About This Medication

# AZ&Me Prescription Savings Program Patient Guide: How to Get Breztri Aerosphere at Low or No Cost ## About This Program The AZ&Me Prescription Savings Program is a patient assistance program sponsored by AstraZeneca, the manufacturer of Breztri Aerosphere. This program helps eligible patients obtain their COPD medication at reduced or no cost if they cannot afford their prescription. ## About Breztri Aerosphere Breztri Aerosphere is an inhaled combination medication used to treat chronic obstructive pulmonary disease (COPD). It contains three active ingredients: - **Budesonide** (an inhaled corticosteroid that reduces inflammation) - **Glycopyrrolate** (a long-acting anticholinergic that helps open airways) - **Formoterol** (a long-acting beta-agonist that relaxes airway muscles) This triple-combination therapy helps improve breathing and reduce COPD symptoms when used regularly. ## Who Can Apply? You may qualify for the AZ&Me program if you meet these criteria: 1. **You have no prescription drug coverage** that helps pay for AstraZeneca medicines, OR 2. **You participate in Medicare Part B or Part D** and face difficulty affording your medication 3. **Your household income falls within the program limits** (see income table below) 4. **You are a U.S. resident** 5. **You have a valid prescription** for Breztri Aerosphere from a licensed healthcare provider ## Income Eligibility The program's income limits vary based on household size. The exact thresholds fluctuate, so we recommend contacting the program directly for current limits. Generally, the program accommodates a wide range of income levels, including many middle-income households. | Household Size | Income Limit* | |---|---| | 1 person | Varies | | 2 people | Varies | | 3 people | Varies | | 4 people | Varies | | 5+ people | Varies | *Current limits available at https://www.azandmeapp.com or by calling (800) 292-6363 ## Insurance Requirements You are typically eligible if: - You have **no prescription drug coverage** that assists with AstraZeneca medicines, OR - You have **Medicare Part B or Part D** and still struggle to afford your medication If you have private insurance or other coverage, you may still qualify depending on your specific situation. Contact the program to discuss your coverage details. ## Step-by-Step Application Instructions ### Step 1: Gather Required Documents Before applying, collect the following: - Completed application form (signed by you and your prescriber) - Your prescription for Breztri Aerosphere - Medicare documentation (if applicable) - Proof of income (recent tax return, pay stub, or benefit statement) - Insurance information (if applicable) ### Step 2: Choose Your Application Method The AZ&Me program offers **multiple ways to apply**: **Online Application:** - Visit https://www.azandmeapp.com - Complete the digital form with your personal and medical information - Upload or attach required documents - Submit electronically **Phone Application:** - Call **(800) 292-6363** - Speak with a program representative who will guide you through the application - Have your documents ready to provide information - The representative can answer questions about eligibility **Fax Application:** - Print the application form from the website - Have your doctor sign the prescription section - Fax completed form to **(1-800-961-8323)** - Include all required supporting documents **Mail Application:** - Request application materials by phone or download from the website - Complete all sections - Obtain your prescriber's signature - Mail all documents to the address provided on the application form ### Step 3: Submit Your Application Make sure your application includes: - Your signature and your prescriber's signature - Complete prescription information - Medicare documentation (if you receive Medicare) - Any income verification documents ### Step 4: Wait for Approval The program typically processes applications in **4-8 weeks**. You may want to verify the current timeline when you apply, as processing times can vary. ### Step 5: Receive Your Medication Once approved, Breztri Aerosphere will be **shipped directly to you**. Keep track of: - Your confirmation number - Expected delivery date - Any tracking information provided If you don't receive your medication within the expected timeframe, contact the program using the phone number above. ## Program Benefits - **Low or no-cost medication** for eligible patients - **Direct home delivery** of your Breztri Aerosphere - **Annual reauthorization** required to maintain benefits - **No savings card needed** for this program (medication is provided directly) - **Multiple application methods** for your convenience ## Reauthorization and Refills Your approval is valid for **one year**. You will need to reauthorize annually to continue receiving medication through the program. The program will notify you when it's time to renew. Reauthorization typically requires: - Updated application or brief renewal form - Current income documentation - Continued proof of eligibility - Valid prescription from your doctor ## What If Your Application Is Denied? If you don't qualify for the AZ&Me program, consider these alternatives: 1. **Work with your doctor** to explore other COPD medications that may be covered by your insurance or other assistance programs 2. **Contact patient advocacy organizations** for COPD (such as the COPD Foundation) for additional resources 3. **Check state pharmaceutical assistance programs** that may help residents with medication costs 4. **Review your insurance coverage** to see if you can appeal a formulary decision 5. **Ask your prescriber** about generic alternatives or samples 6. **Visit NeedyMeds.org** for a comprehensive list of additional assistance options ## Important Tips - **Start early**: Allow 4-8 weeks for processing, so apply before you run out of medication - **Keep prescriptions current**: Ensure your doctor renews your prescription before it expires - **Update information**: Notify the program if your income, address, or insurance changes - **Document everything**: Keep copies of your application, confirmation number, and correspondence - **Call with questions**: Don't hesitate to contact (800) 292-6363 if you need help ## Contact Information - **Website**: https://www.azandmeapp.com - **Phone**: (800) 292-6363 - **Fax**: 1-800-961-8323 - **Hours**: [Contact program for available hours] ## Legal Disclaimer This guide provides general information about the AZ&Me Prescription Savings Program for Breztri Aerosphere. Program details, eligibility requirements, and income limits may change. For the most current and accurate information, please visit the official program website or contact the program directly. This guide is not a substitute for professional medical advice. Always consult with your healthcare provider about your COPD treatment and medication needs. Inclusion in this guide does not guarantee approval for assistance. --- **Remember**: The goal of this program is to ensure that financial hardship doesn't prevent you from accessing the medication you need to manage your COPD effectively. If you have any questions about eligibility or the application process, reach out to the program team—they are there to help you.

Program information last verified: March 25, 2026