Qtern

Indicated For

type 2 diabetes

About This Medication

# AZ&Me Prescription Savings Program Patient Guide: How to Get Qtern at Low or No Cost ## About This Program The AZ&Me Prescription Savings Program is AstraZeneca's patient assistance program designed to help uninsured and underinsured patients access their medications at reduced or no cost. If you've been prescribed Qtern (dapagliflozin/saxagliptin) to help manage your Type 2 diabetes and are struggling with the cost, this program may be able to help. ## About Qtern Qtern is a combination medication that contains two active ingredients: - **Dapagliflozin**: An SGLT2 inhibitor that helps your kidneys remove excess glucose through urine - **Saxagliptin**: A DPP-4 inhibitor that helps your pancreas release more insulin when blood sugar is high Together, these medications help lower blood sugar levels in adults with Type 2 diabetes. Your doctor prescribed this medication because they believe it's the right choice for your diabetes management plan. ## Who Can Apply? You may be eligible for the AZ&Me Prescription Savings Program if you meet these criteria: **Insurance Status:** - You do NOT have prescription drug coverage through a private insurance plan - You do NOT have coverage through a government program (with one exception: see Medicare information below) - You are a U.S. resident **Medicare Patients:** If you have Medicare, you are generally not eligible for this program unless you do not qualify for the Low Income Subsidy (LIS). Talk to your doctor or pharmacist about other options, including state pharmaceutical assistance programs. ## Income Eligibility While exact income thresholds can vary, the program typically serves patients with household incomes at or below 200-400% of the federal poverty level. Use this chart as a general guide for 2024: | Household Size | Approximate Maximum Annual Income | |---|---| | 1 person | $27,000-$54,000 | | 2 people | $36,000-$73,000 | | 3 people | $45,000-$91,000 | | 4 people | $55,000-$110,000 | | 5 people | $65,000-$130,000 | | 6 people | $78,000-$156,000 | | 7 people | $89,000-$178,000 | | 8 people | $100,000-$200,000 | *Note: These are estimates. Your actual eligibility depends on current program guidelines. Contact the program for exact thresholds.* ## What Documents You'll Need Before starting your application, gather these items: 1. **Income Verification**: Recent tax return, pay stubs, benefit statements, or a signed affidavit of income 2. **Prescription**: A written or electronic prescription from your doctor for Qtern 3. **Proof of Citizenship/Residency**: A valid government-issued ID or proof of U.S. residency 4. **Insurance Information**: If applicable, documentation showing you don't have prescription coverage ## How to Apply: Step-by-Step Instructions ### Step 1: Get Your Prescription Make sure your doctor has written a prescription for Qtern. This is a required document for all applications. ### Step 2: Choose Your Application Method The AZ&Me Program accepts applications through multiple methods: - **Phone**: Call the program to apply with a representative who will guide you through the process - **Mail**: Download and complete the application form and mail it with supporting documents - **Online**: Visit the AstraZeneca website to complete an online application form - **Through Your Pharmacy**: Some pharmacies can help you apply in person ### Step 3: Complete the Application Whichever method you choose, you'll need to provide: - Your personal information (name, date of birth, address, phone number) - Your household size and annual income - Your prescription for Qtern - Income verification documents - Insurance status information ### Step 4: Submit Your Application Mail, call, or submit your application through the method you selected. Keep copies of everything you submit. ### Step 5: Wait for Approval The program typically processes applications within 4-8 weeks. You may receive updates by phone, email, or mail depending on how you applied. ### Step 6: Receive Your Medication Once approved, your medication will be delivered to you or to your pharmacy. The delivery method varies depending on the program option you're enrolled in. ## Timeline and What to Expect **Application Processing:** - Standard processing time: 4-8 weeks - You may be contacted if additional information is needed - Once approved, you'll receive a confirmation **Medication Delivery:** - Delivery options vary by program - Some programs deliver directly to your home - Others may send prescriptions to your pharmacy - Ask about the delivery method when you apply **Program Duration:** - Your enrollment lasts 12 months - You'll need to reauthorize your enrollment after 12 months - You'll receive a reminder before your authorization expires ## Additional Savings Options Even if you don't qualify for the full patient assistance program, AstraZeneca offers other ways to save: **AZ&Me Savings Card:** - Available even if you have insurance - Can provide discounts on Qtern at participating pharmacies - Visit the AstraZeneca website to download or request a card - No copay may be as low as $0-$10 per prescription ## What If You're Denied? If your application is denied: 1. You'll receive a letter explaining the reason 2. Common reasons include income above program limits or having active insurance coverage 3. Ask about alternative programs or the savings card option 4. Consider applying to state pharmaceutical assistance programs 5. Speak with your doctor about lower-cost alternative medications 6. Contact patient advocacy organizations for additional resources ## Important Reminders - **Don't delay treatment**: While waiting for approval, ask your doctor about temporary options or samples - **Be honest on your application**: Providing false information can disqualify you - **Keep your information current**: Notify the program of any changes in income or address - **Mark your calendar**: Remember to reauthorize after 12 months to avoid gaps in coverage - **Ask questions**: If anything is unclear, contact the program before submitting ## Legal Disclaimer This guide provides general information about the AZ&Me Prescription Savings Program based on typical program requirements. However, program eligibility criteria, income limits, required documents, and benefits may change at any time. For the most current and accurate information about the program, including specific income thresholds and eligibility requirements, please contact AstraZeneca directly or visit their official website. This information should not be considered legal or medical advice. Always consult with your healthcare provider or a qualified professional regarding your specific situation. ## Additional Resources - **NeedyMeds.org**: Database of patient assistance programs and other medication resources - **Partnership for Prescription Assistance**: Helps uninsured patients find assistance programs - **Your State Pharmaceutical Assistance Program**: Many states offer additional help for medications - **Your Pharmacist**: Can often help with applications or suggest other options - **Patient Advocacy Organizations**: Diabetes-focused nonprofits may have additional resources

Program information last verified: January 26, 2026