To apply to the Amgen Safety Net Foundation, download the application form for your specific Amgen medication, complete the patient section yourself, have your prescribing doctor fill out and sign the healthcare provider section, and submit the packet with proof of income and insurance by fax to 866-549-7239 or by mail to PO Box 15980, Phoenix, AZ 85060. The foundation charges no fee, and if approved you receive your medication at no cost for up to 12 months.
Confirm You Qualify Before You Apply
Three things decide eligibility: residency, insurance, and income. You must have lived in the United States or a U.S. territory for at least six months.1Amgen Safety Net Foundation. Check Eligibility Requirements The program is built for patients who are uninsured, underinsured, or enrolled in a government program such as Medicare Part D. If you have commercial insurance that denied coverage for the medication entirely, you may still qualify, but you have to exhaust your plan’s appeals process first and include documentation of the denial.
Income caps are tied to the Federal Poverty Level and differ depending on which Amgen drug you need. The foundation publishes two tiers of household income guidelines covering the 48 contiguous states, Guam, Puerto Rico, and the U.S. Virgin Islands, with higher caps for Alaska and Hawaii. Because the foundation updates these figures each year when HHS publishes new poverty guidelines, check the eligibility page for your specific medication before applying.1Amgen Safety Net Foundation. Check Eligibility Requirements
If You Have Medicare Part D
Medicare patients face an added requirement. You have to show an affordability gap and demonstrate that you do not have access to other financial support such as Medicare Extra Help (the Low Income Subsidy) or an independent copay foundation.1Amgen Safety Net Foundation. Check Eligibility Requirements That means applying for Extra Help through Social Security first. If Extra Help covers you, the foundation will not step in.
Gather Your Documents First
Missing paperwork is the fastest way to have your application sent back. Have everything in hand before you start filling out the form.
- Proof of income: a signed copy of your most recent IRS Form 1040. If you did not file, W-2 or 1099 forms work. If you receive Social Security retirement or disability benefits, submit your Social Security Award letter or benefit verification statement.
- Insurance documentation: photocopies of the front and back of every card you carry, including medical, pharmacy, and any supplemental plans. If the foundation cannot read the copy, the application stalls.
- The exact name of the Amgen medication your doctor prescribed. The application is medication-specific.
- Your prescribing physician’s office phone number and National Provider Identifier (NPI). The doctor’s office will have the NPI on hand.
Download the Correct Form
The foundation uses a separate application for each medication it covers. Go to the Resources and Forms page at amgensafetynetfoundation.com/resources-forms.html and select your prescribed medication to get the right PDF.2Amgen Safety Net Foundation. Resources and Forms Check the product name on the form header against your prescription. Submitting the wrong drug’s form will delay you.
Complete the Patient Section
The top half of the form is yours. It asks for your legal name, date of birth, mailing address, phone number, and an email if you have one.
The insurance disclosure asks you to describe your current coverage: uninsured, commercial, or a government program like Medicare or Medicaid. If you have pharmacy benefits through a separate plan or a pharmacy benefit manager, note that. Address every checkbox. Skipping even one is a common reason applications come back for clarification, and each round trip adds weeks.
The income section asks for your gross annual household income and the number of people in your household. Household income means the combined earnings of everyone living with you, not just yours. Report the figure accurately, because the foundation compares it against the tax documents you attach.
At the bottom of your section is an authorization and signature block. Your signature lets the foundation share limited health information to confirm your eligibility. Sign and date it. An unsigned or undated authorization is the single most common reason applications get held up.
Have Your Doctor Complete Their Section
The prescribing physician, or a designated member of their clinical staff, fills out the second half of the form. You cannot complete this part yourself. Bring the form to your next appointment, or send it to the office and ask them to complete their portion and submit the whole package.
The provider section covers the physician’s professional license number, NPI, office address, and the ICD-10 diagnosis code supporting the prescription. The doctor signs to certify that the medication is medically necessary. Without that signature, the foundation will not process the application.
The foundation does not charge for its services, and no legitimate third party should charge you a monthly fee to help enroll. Anyone doing so is not affiliated with the program.3Amgen Safety Net Foundation. Amgen Safety Net Foundation
Submit the Application
Once both sections are signed and all documents are attached, send the packet one of two ways:
- Fax to 866-549-7239. This is the faster route. Save the transmission confirmation page as proof of delivery.
- Mail to Amgen Safety Net Foundation, PO Box 15980, Phoenix, AZ 85060. Use a method with tracking.4Amgen Safety Net Foundation. Patient Application Form – Enbrel
Make copies of everything you send. If the foundation calls about a missing document, you can resend quickly without rebuilding the packet.
What Happens After You Submit
The foundation reviews complete applications and verifies your income documentation and your doctor’s credentials. If anything is missing or unclear, the foundation contacts you or your physician’s office using the phone numbers on the form, so accurate contact information matters.
To check status, call the foundation at 888-762-6436.5Amgen. Contact Us Have your name and date of birth ready so the representative can pull your file.
Once you are approved, medication for certain products ships monthly directly to the healthcare facility where it is administered, based on your treatment records.6Amgen Safety Net Foundation. Product Replacement Request Form Self-administered drugs like injectables may follow a different path. Your doctor’s office or the foundation can confirm how you will receive your specific medication.
Re-Enroll Before the 12-Month Window Closes
Approval lasts up to 12 months. After that, your enrollment expires and you have to submit a brand-new application to keep getting your medication at no cost.7Amgen Safety Net Foundation. How to Apply There is no automatic renewal. The foundation re-evaluates your income and insurance each time.
Start early. If you wait until the last week of your 12-month period, you may face a gap in medication access while the new application is reviewed. Begin pulling updated income documents and contacting your doctor’s office roughly a month before your enrollment expires.