Application process chart

If you meet all five (5) eligibility criteria and funding is available, your application will be approved pending supplemental documents.

Please check your e-mail for a link to complete the required Supplemental Documents through DocuSign.

Alternatively, if you applied by paper application, please submit the Supplemental Documents by mail, fax, or drop-off at any SCVMC Outpatient Pharmacy. The Supplemental Documents are available on the Forms page of the MedAssist website.

Failure to submit the supplemental documents within thirty (30) calendar days will result in your application being withdrawn.

Required Supplemental Documents Checklist*:

  1. Automated Clearing House (ACH) Registration
  2. W-9

*You will be contacted using the information you provided if any additional information or documents are required.

Please login to the portal here to check the details of your application approval and grant award or contact the MedAssist office.

If you applied by mail, fax, or drop-off at a SCVMC Outpatient Pharmacy, you will be notified of any changes to your application status by letter and/or phone.


Grant Payments

Upon approval of your application, you will be awarded a grant for each disease state or medical condition that you provided a valid prescription for. You may be eligible to receive up to three (3) grants.

Prescription Grant Type (Disease State or Medical Condition)
Diabetes Medication Diabetes
Asthma Inhaler Asthma
Epinephrine Auto-injector Severe Allergies


Your first grant payment will be issued within ten (10) business days of your application approval date.


To receive subsequent grant payments, you will need to return to the MedAssist portal every month to submit proof of refill of a qualifying prescription. For as needed medications, a signed attestation form will be accepted. 

Alternatively, you may submit your documents via mail, fax, or drop-off at any SCVMC Outpatient Pharmacy.

The document of proof that you are asked to submit depends on the type of your grant. See details in table below.

Grant Type Document of Proof
Asthma Proof of refill (Prescription fill history) or Asthma Inhaler Attestation Form
Diabetes Proof of refill  (Prescription fill history)
Severe Allergies Epinephrine Attestation Form

Please request a prescription fill history by contacting your pharmacy. The following information must be included on the fill history:

  • Pharmacy name
  • Pharmacy phone number
  • Pharmacy address
  • Medication name
  • Date Rx filled
  • Quantity

The deadline to submit the document of proof is the last day of the month. However, there is a thirty (30) calendar day grace period for you to submit the document of proof. Once this grace period has ended, you will not be able to receive a grant payment for this month.

Month Deadline for Submission
June 2022 June 30, 2022
July 2022 July 31, 2022
August 2022 August 31, 2022
September 2022 September 30, 2022
October 2022 October 31, 2022
November 2022 November 30, 2022
December 2022 December 31, 2022
January 2023 January 31, 2023
February 2023 February 28, 2023
March 2023 March 31, 2023
April 2023 April 30, 2023
May 2023 May 31, 2023
June 2023 June 30, 2023

The default method of payment is direct deposit however you have the option to receive grant payments via paper check. Please select “check” for your payment method on the ACH Registration form to opt-out of direct deposit.  

You can always check the details of your grant by logging into the portal here or by contacting the MedAssist office.