Step 1: Apply

• The application form can be downloaded here. You may also request that an application be sent to you by mail by emailing us at This e-mail address is being protected from spambots. You need JavaScript enabled to view it  or click here contact us.

Step 2: Award Determination  

• You must complete the form and return it to us with all applicable documentation to be considered for assistance.
• Cancer Copay Relief determines awards based on participants needs and current funding available.

• Approved participants will receive an awards letter by mail with further instructions.

Step 3: Payments

• When we determine the amount and nature of your grant, you will be notified by mail. Typically, grants are paid directly to medical care providers and pharmacies.

Cancer Copay Relief does not restrict the medical provider or pharmacy selected by the patient. You may change your providers at any time during your award period but. You are responsible for transferring any credits on your award. The Cancer Copay Relief reserves the right to change any or all parts of its program at any time with or without notice.


For more information, please contact us.