Davy Care Eligibility Form

👋 Hi, we're Davy Care — your prescription savings advocate

We help people just like you find ways to afford the medications they need. This quick quiz helps us understand your situation so we can match you with the best savings programs.

What brings you here today?*

I was just prescribed an expensive medication and don't know how I'll afford itI recently lost my insurance or had a major change in coverageI’ve been struggling with high medication costs for a while and need a better long-term solutionI’m trying to find out what help is available to lower my medication costsI’m helping a family member or loved one find affordable medicationsOther (Please Specify)

Do you currently have health insurance?*

No, I don’t have insuranceYes, I have private/commercial insuranceYes, I have MedicareYes, I have MedicaidI'm not sure

Unfortunately, we can’t help with Medicaid yet

Right now, most prescription assistance programs don’t work with Medicaid coverage. We know that’s frustrating — and we’re working hard to expand our services.

In the meantime, you can:
- Learn about your state’s Medicaid prescription benefits at Medicaid.gov
- Explore extra help programs offered by your state

Have you applied for Medicare’s Extra Help or Low Income Subsidy (LIS) program?*

Yes, I'm enrolled in Extra HelpYes, but I was deniedNo, I haven't applied

It looks like you may not qualify based on your income

Most savings programs are only available to households earning under 500% of the Federal Poverty Level (FPL). Based on your income and household size, you may be above that limit.

But there are still ways to save on your prescriptions:
- Use a discount card like GoodRx and SingleCare to find lower prices
- Check for manufacturer co-pay cards on the brand’s website if you have insurance
- Ask your doctor or pharmacist about generics or more affordable alternatives

About how much do you currently spend each month on prescriptions?*

Less than $50$50 – $100$100 – $300More than $300

You may qualify for prescription savings!

At Davy Care, we’re your prescription savings advocate — real people who handle the hard stuff so you can afford the medications you need.
- We'll guide you every step of the way
- We take care of the paperwork and coordination
- You only pay if we save you money

Let's get you started

Your advocate will review your situation and reach out to guide you through the next steps.
Name*

First NameLast Name
Email*
Phone Number*
State*

Street Address

Street Address Line 2

City

Zip Code
I acknowledge that I have read and agree to the Davy Care Terms of Service and Privacy Policy. I authorize Davy Care to contact me via email, phone, and text messages—including via automated technology—about my application and related services. Standard messaging rates may apply, and I understand that I can opt out at any time. and
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