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How To Apply

Applying for PAN assistance is easy.

There are two ways to start the application process for yourself or on behalf of someone else:

1. Call 1.866.316.PANF1.866.316.PANF (7263). A dedicated PAN counselor will work with you directly to help you:

  • Assess your eligibility for assistance
  • Provide you with an application for assistance
  • Complete your application
  • Answer questions regarding the application process

2. Start Application Online

Complete a pre-screen online; print and complete the PDF application provided after the pre-screen; and submit it by mail or fax.

All applications and accompanying materials can be submitted by:

Patient Access Network Foundation
P.O. Box 221858
Charlotte, NC 28222-1858


Application materials are provided on a patient-by-patient basis. Patients and their physicians will be notified in writing of the eligibility determination upon receipt and review of their completed applications.

To be eligible for assistance, patients must be U.S. residents and must meet certain financial, insurance, and medical criteria established by the Foundation's Board of Directors. We no longer require income verification, but be prepared if you are selected for a randomized audit.