💊 How to Fax a Patient Assistance Program Application
Each drug maker runs its own patient assistance program, and the fax number can change from one drug's form to another, so use the number printed on the current application for your drug. AZ&Me (AstraZeneca) prints fax 1-877-239-0867 and Bausch Health prints fax 844-705-0160. You can fax your own patient pages, and a cover page plus a two-page patient section costs $2.99, but the prescriber's part should come from the doctor's office, because OverseasFax is not HIPAA compliant and does not sign a BAA.
📋 In This Guide
Each Program Has Its Own Fax Number
A patient assistance program (PAP) is run by the company that makes the drug, so there is no shared fax number. Take the number from the current application form for your specific drug, because some companies use different numbers for different products. These are the numbers we checked on official forms in October 2026.
| Program | Fax | Other ways |
|---|---|---|
| AZ&Me (AstraZeneca) | 1-877-239-0867 | Online application, or phone 1-800-292-6363 |
| Bausch Health PAP | 844-705-0160 | Phone 833-862-8727, or mail to P.O. Box 991624, Louisville, KY 40269 |
| Pfizer Oncology Together PAP | 1-877-736-6506 | Mail to the Lewisville, TX address on the form |
| Pfizer Velsipity PAP | 1-646-862-9655 | Mail to the Lewisville, TX address on the form |
Pfizer's other programs start at the Pfizer RxPathways Program Finder, where you fill in the form online, and then you and your prescriber print your parts and send them by mail or fax. Pfizer says the information you enter online is not sent to Pfizer until you submit it that way, so the fax number is on the form it gives you.
Who Signs and Who Sends
Most applications have a patient part and a prescriber part. The AZ&Me form tells the patient to sign and fax the patient form together with the provider form, and the provider form is signed and faxed by the doctor's office. AZ&Me says both forms must be received before it can decide, and the prescriber signature must be a wet signature. On the Pfizer Oncology Together form, the prescriber must sign and date Sections 10 and 13, and without Section 13 the patient cannot be considered. Bausch Health accepts electronic, stamped and e-signed signatures, but not stamped signatures for controlled substances.
The rule: fax your own patient pages yourself, and ask the doctor's office to send the prescriber pages from its own system. OverseasFax is not HIPAA compliant and does not sign a business associate agreement (BAA), so a doctor's office should not use it for patient information, while a patient may fax their own documents.
Entering the Program's Fax Number
Select United States and type all 10 digits, starting with the area code. Do not type the leading 1, because +1 is added for you, and the box removes a 1 if you type one. The pay button turns on only at 10 digits. The AZ&Me number 1-877-239-0867 is entered as 8772390867, and the Bausch Health number 844-705-0160 is entered as 8447050160. More help is in how to fax a US number online.
What to Include and How to Label It
Each program asks for different income papers, so follow your form. The Pfizer Oncology Together form can check income electronically if you sign Section 4; if not, it asks for your most recent federal tax return, W-2s, or the three most recent pay stubs for everyone in the household. Bausch Health asks for the first two pages of your latest tax return, insurance cards front and back, and proof that you have no coverage or that your appeals are used up. AZ&Me asks for household income and size on the form and may estimate income from credit and other data.
On the cover page, write the program name and the drug name, your full name and date of birth, your phone number, the words "Patient section attached", and the page count. Put your name and date of birth at the top of every page and number the pages, such as "Page 3 of 6". Missing information can slow things down; Pfizer says missing information or consents may cause delays, and Bausch Health says processing time depends on how complete the application is.
Timing and Yearly Renewal
We found no fixed federal deadline for these applications, because each company sets its own process. The programs we checked do not promise a review time on their forms, so send your part as soon as your prescriber is ready to send theirs. If you are on Medicare and use AZ&Me, its site says Medicare patients enrolled now will not be automatically re-enrolled for 2027, so watch for its renewal steps. Bausch Health asks people who are likely eligible for Medicare Extra Help to apply for that first and to include the denial letter, and it limits help to households at or below 300% of the Federal Poverty Level.
Cost, Your Record and a Failed Fax
A cover page and a two-page patient section is 3 pages, which costs $2.99. With two pages of tax return and two insurance card pages added, 6 pages comes to $2.99 + 3 x $0.99 = $5.96. You see the total before you pay, and you can upload up to 10 files in one fax.
There is no account, nothing is printed on your document, and delivery usually takes a few minutes. The confirmation email shows the destination number, the page count and the time in US Eastern Time, which is your record of exactly when it was sent. If the fax cannot be delivered, the full amount goes back to your card automatically.
When the Program Writes Back
If the program or your doctor's office wants to fax a page back to you, our sister service GetAFax.com gives you a private US fax number for 24 hours for $5, for up to 30 pages, and faxes arrive in your email as a PDF. If your drug plan is also involved, see how to fax a prior authorization to a drug plan, and for proof of income papers see how to fax employment income verification. All US guides are listed in the US fax guide.
Why send it here
One price for the whole fax, shown before you pay, and nothing added at checkout.
Nothing is printed on your document. It arrives exactly as you uploaded it.
If it cannot be delivered, the money goes back to your card without you asking.
It works from anywhere in the US, in any browser, with no account.
Frequently Asked Questions
How much does it cost to fax a patient assistance program application?
Is there a free way to fax my AZ&Me or Pfizer PAP form?
What is the AZ&Me fax number?
What is the Bausch Health patient assistance program fax number?
What fax number do I use for the Pfizer Patient Assistance Program?
Is 877-548-1734 the Pfizer patient assistance fax number?
I filled out the Pfizer RxPathways form online, do I still need to fax it?
Can I fax my part of the AZ&Me application and let my doctor fax theirs?
Can my doctor's office fax my patient assistance application with OverseasFax?
How do I enter the AZ&Me fax number 1-877-239-0867?
Can a patient assistance program fax me back if pages are missing?
Is OverseasFax HIPAA compliant for a patient assistance application?
How do I know my Bausch Health PAP fax went through?
My PAP application fax failed, what should I do?
Does my doctor need a wet signature on the AZ&Me provider form?
Does Bausch Health accept a stamped doctor signature on its PAP form?
What proof of income does the Pfizer Oncology Together PAP want?
What is the income limit for the Bausch Health patient assistance program?
I have Medicare and use AZ&Me, will I be renewed automatically for 2027?
What should my cover page say when I fax a patient assistance application?
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📖 Fax Medicaid Renewal Documents Online
📖 How to Fax From a Windows PC
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