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How To Apply

Applying for PAN assistance is easy.

You can start the application process for yourself or on someone else's behalf one of two ways:

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 fill out 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. All patients and their physicians will be notified in writing of the eligibility determination upon receipt and review of your completed application.

To be eligible for assistance, you must be a U.S. resident and 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.