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Verified Checked 08/17/26

BEVESPI patient assistance

glycopyrrolate-and-formoterol-fumarate · AstraZeneca Pharmaceuticals LP

A documented program may help with BEVESPI. Eligibility depends on the program’s current rules; the program makes the final decision.

What it costs

$0

A pharmacy price is not confirmed for this record.

Maker
AstraZeneca Pharmaceuticals LP
Program
AZ&Me Prescription Savings Program
Income limit, 1 person
$79,800/yr
Income limit, family of 4
$165,000/yr
Last verified
08/17/26

The program's own page · Our verification method

Your options, in order

Which option fits depends on your insurance and the program’s current rules. Use the official application; a paid paperwork service is a separate choice.

  • AZ&Me Prescription Savings Program, run by AstraZeneca Pharmaceuticals LP, provides the medication at no cost if you qualify. One eligibility path: "You don't have insurance (or only have Medicare)."

    What it costs you
    $0
    Income limit, 1 person
    $79,800/yr
    Medicare
    Has a Medicare eligibility path.
    Checked
    08/17/26

    You don't have insurance (or only have Medicare)

    • ·300% FPL applies to Primary and Specialty Medications (nearly all AZ&Me drugs). Rare Disease Medications (currently WAINUA only) use a separate 500% FPL tier — see the 'rare-disease-drug' extra condition below. 48-state dollar table (effective 2026-01-26): 1p $47,880, 2p $64,920, 3p $81,960, 4p $99,000, 5p $116,040, 6p $133,080, 7p $150,120, 8p $167,160. Alaska and Hawaii use higher published tables.
    • ·300% of the federal poverty level. Household dollar amounts and regional applicability must be confirmed with the program.
    • !Must not have any commercial (private or employer-sponsored) insurance, and no government insurance other than Medicare.
    • !Must not be receiving any other form of medication assistance (stacking prohibition).
    • !For Rare Disease Medications (WAINUA), the income limit is 500% FPL instead of 300% FPL: 48-state table 1p $79,800, 2p $108,200, 3p $136,600, 4p $165,000, 5p $193,400, 6p $221,800, 7p $250,200, 8p $278,600.
    • !A 'Change in Circumstance' exception (job loss, income change, insurance loss, household-size change) can reopen eligibility outside normal criteria.

    You have Medicare but don't qualify for Extra Help (LIS)

    • ·Same 300%/500% FPL split by medication category as the no-insurance track (this is the SAME income rule applied to a distinct insurance-status population — Medicare beneficiaries, rather than the fully uninsured).
    • ·300% of the federal poverty level. Household dollar amounts and regional applicability must be confirmed with the program.
    • !Patient must be covered by Medicare but must NOT be eligible for or enrolled in Medicare's Extra Help / Low-Income Subsidy (LIS) for Part D
    • !this is a blanket LIS-ineligibility requirement with no FPL carve-out stated (contrast: AbbVie only requires proof of LIS denial below 150% FPL).
    • !Must not have any commercial insurance other than Medicare.
    • !Must not be receiving any other form of medication assistance (stacking prohibition).
    • !For Rare Disease Medications (WAINUA), the income limit is 500% FPL instead of 300% FPL (same split as the no-insurance track).

    Program website

How to apply

Follow the current program’s application instructions. Documents, review times and approval requirements vary.

Approval is not permanent. Use your approval notice to track the end date and any renewal requirements.

  1. 1

    Confirm the program

    Check its current medication list, benefit and eligibility requirements.

  2. 2

    Gather the required documents

    Use the current application to identify income and insurance documents the program accepts.

  3. 3

    Coordinate with your prescriber

    Ask whether the program needs a prescription, clinical information or signature.

  4. 4

    Submit and follow up

    Confirm receipt, ask about the decision and keep any approval or renewal dates.

If this is more than you want to take on

Help with the paperwork for BEVESPI

You can follow the official application yourself. A paid service may help with documents and follow-up; ask exactly what its fee includes.

Compare published fees, cancellation terms and available reviews. Paying for paperwork does not establish coverage or guarantee approval.

  • Ask which forms and submissions the service handles
  • Ask how the service coordinates with your prescriber
  • Check whether renewal assistance is included
Compare services that help you apply

A paperwork service is optional. Check the program directly first.

Common questions

  • Is assistance confirmed for BEVESPI?

    A documented program may help with BEVESPI. Eligibility depends on the program’s current rules; the program makes the final decision.

  • Does income alone establish eligibility?

    No. Medication coverage, insurance and other program requirements may also matter. The program makes the final decision.

  • Do I have to pay a company to apply?

    Follow the official program’s application instructions. Paid paperwork services are optional and do not guarantee approval.

  • How long does approval last?

    Approval and renewal periods vary by program. Check the current terms and your approval notice.

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