Get Pei Drug Cost Assistance Program Application - Government Of ... - Gov Pe

The PEI Drug Cost Assistance Program Application is a critical document used to apply for financial assistance with prescription drug costs. This guide provides clear, step-by-step instructions to help users complete the application accurately and efficiently online.

Follow the steps to fill out the application form online.

1. Press the ‘Get Form’ button to obtain the application form and open it for editing.
2. Begin by entering your personal information in the designated fields. Include your surname, first name, initial, PEI Health Care Card number, date of birth, marital status, and social insurance number.
3. Next, provide your mailing address, including the street or PO Box, building or apartment number, city or town, province, and postal code. Be sure to include your telephone number, email address, and mobile number.
4. In the dependent information section, list all dependent children under the age of 18 or aged 18 to 25 who are attending a post-secondary institution full-time. Ensure to provide their surname, first name, initial, gender, provincial health card number, date of birth, and social insurance number.
5. Indicate whether you, your spouse, or dependent children have private drug insurance coverage. If yes, fill in the name of the insurance company, the terms of coverage, policy number, and whether you pay the premium.
6. Complete the declaration and consent section by reading the statements carefully. Sign and date where indicated, confirming that all information provided is true and correct.
7. Review the entire application to ensure all required fields are filled out accurately. Once completed, save the document, download it if necessary, and prepare it for submission.
8. Finally, submit the completed form by mailing it to PEI Pharmacare at the address provided in the application.

Begin your application process online today to access the support you need for prescription drug costs.