Amy Fair

Rx for Oklahoma is a prescription assistance program designed to help Oklahoma residents, regardless of age, who are uninsured or underinsured.

Medicare Part D and Medicaid beneficiaries with unique circumstances may qualify.

You can call 1-877-RX4-OKLA or go one of the KI BOIS Community Action offices or other Community Action Agencies designated for your county. RX for Oklahoma staff will take your information including name, age, address, and income as well as prescription(s) needed and dosage information. This information is then entered into a computer database that generated the appropriate paperwork for the pharmaceutical companies for which you are eligible.

RX for Oklahoma staff assists you with the completion of the application and required documentation for submission. The entire process takes approximately four to six weeks to complete, so only long term medications will qualify.

Health and Happiness

For more information:

Haskell County	918.967.3325
Latimer County	918.465.3381
LeFlore County	918-647-3267
Pittsburg County	918-423-3525
Sequoyah County	918-776-0848

Eligibility

Oklahoma residents, regardless of age, who are uninsured or underinsured are encouraged to apply. Medicare Part D and Medicaid beneficiaries with unique circumstances may qualify.

Those wishing to apply for the program need to provide the following:

Age
Social Security Number
Residential address
Gross annual household income
- Federal Income Tax Return (1040)
- 1099 from Social Security (if applicable)
- 30 day Income Verification (check stubs, social security income letter, etc.)
complete list of medications you are taking and physician information
Insurance coverage (if applicable)
SoonerCare (Medicaid) Denial Letter (if applicable)

Note: We cannot guarantee the approval for any program, as each decision is made by the pharmaceutical company.

	Rx for Oklahoma Application -- Haskell Co.
	Rx for Oklahoma Application -- Latimer Co.
	Rx for Oklahoma Application -- LeFlore Co.
	Rx for Oklahoma Application -- Pittsburg Co.
	Rx for Oklahoma Application -- Sequoyah Co.
	Regional Area Service Map
	Rx for Oklahoma TV Spot
	www.RX4OKLA.com