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Fill out this form for a FREE Medication Cost Savings Analysis to see how much money you could save! The information that you provide will be used to determine program eligibility. After you submit this form, a care manager will contact you to get details on the medications that you need help with and let you know what programs are available for you and how much we may be able to save you. You will not be charged money for this analysis. If you choose to have AdvocHealth provide medication care services after reviewing your potential savings, your billing information will be collected at that time. A nominal, non-refundable, monthly service fee will be implemented and the first payment will be collected. This fee is for the service provided by our care team in efforts to assist you and not for delivery or the cost of your medications. Once AdvocHealth begins support on your behalf, you can expect your brand and specialty medications to be approved in as little as 2-4 weeks.

By checking “I Agree”, you are stating that you understand and agree with the statement above. You are also agreeing that you have read and understand the AdvocHealth Notice of Privacy Rights and Practices which is contained on our website at *


Below you can download the "Notice of privacy Rights." PDF. If you have any questions regarding it's content or any other questions please feel free to contact us via or using this contact form.