Applications for Phone Enrollment—For Patients Who Need Medicine That Same Day

• If you need medicine right away, you must be enrolled over the phone by an Advocate.
• You or your Advocate may request or print applications for same-day access, but only Advocates may initiate the application process by calling Bridges to Access at 1-866-728-4368.
• Each phone enrollment application has a unique 9-digit identification number that serves as your Bridges to Access ID number for as long as you remain in the program. Because the application has a unique ID number, it may not be photocopied.

NOTE: Some medicines for short term use (such as antibiotics) are only available at a retail pharmacy and are not distributed through mail order.

Applications for Mail Enrollment—For Patients Who Want to Self-Enroll

• If you do not need your medicine right away, you can apply on your own by mailing a completed application, along with proof of income and a valid prescription to Bridges to Access.
• When you enroll by mail, you will be assigned a Patient ID number when your application for mail order shipment is processed. The mail enrollment application may be photocopied.