Find the Maryland MEDBANK Program nearest you.

			Who is Eligible?

Maryland residents who meet the financial guidelines, have no other prescription coverage, and are not eligible for entitlement programs like Medicaid or the Maryland Pharmaceutical Assistance Program.

			How the Program Works

• Health care provider and patient completes a referral form, including a list of the patient's prescribed medications.
  
  Referral Form (MS Word format)
  Referral Form (PDF format)
  
  View List of Medications with Programs OR List of Medications by Class*.
  * Note: To download any of the above forms you need Acrobat Reader. Click the logo for a free download.
  
  
• Medbank Program representative identifies Patient Assistance Programs, completes applications and where required obtains written prescriptions from physician.
  
• Most pharmaceutical companies will ship a 90-day supply to the physician's office.

• Patient calls Medbank when medicines are received and the Medbank Program representative repeats applications.

			To Request Assistance:

• Submit Physicians Referral form by fax or mail to MEDBANK.
• Referral form must be complete including patient information.
• Patient proof of income must be provided.
• See list of medication to identify medications available.

  Please click on "Locations"for more information

			Company Programs & Medicare Part D

Medicare Part D Patient Assistance Program Status