Do you qualify for the Program?
You may qualify for the Program if:
✓  You are a U.S. Resident, Green Card or Work Visa holder
✓  You meet certain income limits:

No. of people in your household Total monthly income before taxes Total yearly income before taxes

• 1 person less than $2,917 a month less than $35,000 a year
• 2 person less than $4,000 a month less than $48,000 a year
• 3 person less than $5,000 a month less than $60,000 a year
• 4 person less than $5,833 a month less than $70,000 a year
• 5 person less than $6,667 a month less than $80,000 a year

If you do not meet the requirements listed above but you have recently experienced a change in your financial circumstances (income level and/or prescription drug coverage) and can provide supporting documentation, you may still qualify for the Program.