MEDASSIST PROGRAM

APPLICATION APPROVAL PROCESS

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Failure to submit the supplemental documents within thirty (30) calendar days will result in your application being withdrawn.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

PrescriptionGrant Type (Disease State or Medical Condition)
InsulinDiabetes
Asthma InhalerAsthma
Epinephrine Auto-injectorSevere Allergies

INITIAL GRANT PAYMENT

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

MONTHLY GRANT PAYMENTS

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 or proof of having an unexpired epinephrine auto-injector on hand.

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 TypeDocument of Proof
AsthmaProof of refill (Prescription fill history)
DiabetesProof of refill  (Prescription fill history)
Severe AllergiesEpinephrine 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
  • Days supplied

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.

MonthDeadline for Submission
October 2021October 31, 2021
November 2021November 30, 2021
December 2021December 31, 2021
January 2022January 31, 2022
February 2022February 28, 2022
March 2022March 31, 2022
April 2022April 30, 2022
May 2022May 31, 2022
June 2022June 30, 2022

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.