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Activate a Card
Let’s get started!
Answer the questions below to see if you are eligible for savings.
Step 1:
*Required Field
*Is this savings card for you (the patient) or someone else? If you click “Someone Else,” you are confirming that you have permission to request a card on their behalf.
This field is required.
*Do you (the patient) have health insurance that is the sole or primary coverage for your (the patient’s) medicine?
This field is required.
*Are you (the patient) eligible to enroll in any state, federal, or government-funded medical or prescription benefit programs, including but not limited to Medicare, Medicaid, Medigap, the Veterans Administration (VA), the Department of Defense (DoD), TRICARE, or the AIDS Drug Assistance Program (ADAP)?
This field is required.
Are you (the patient) enrolled in the Ryan White ADAP?
This field is required.
*Does the Ryan White ADAP purchase insurance on your (the patient’s) behalf?
This field is required.
*Please enter the following information from the card you're trying to activate:
*Card ID (number found on the card)
This field is required.
Please enter a valid ID number (must be numeric).
We're sorry, something went wrong. Please try again or call 1‑844‑588‑3288 (toll free) for assistance.
We’re sorry, something went wrong. Talk one-on-one live with out access coordinators for help 1‑844‑588‑3288.
*Confirm Card ID
This field is required.
The ID number doesn’t match.
We're sorry, something went wrong. Please try again or call 1‑844‑588‑3288 (toll free) for assistance.
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