Applying for the Tornado Relief Program with Rx Outreach is quick and straightforward — most people finish in under 5 minutes. Whether you're applying for yourself or on behalf of someone else, we're here to help.

If you were affected by the May 16, 2025, tornado in the St. Louis metropolitan area (Missouri and Southern Illinois), you can receive up to a 90-day supply of medication at no cost. Rx Outreach is a fully-licensed nonprofit mail-order pharmacy based in St. Louis, trusted for affordable and safe access to prescriptions.

Before you begin:

Review more information regarding our Tornado Relief Program → St Louis Area Tornado Relief with Medications Website

To expedite this process, please list all the medications you would like covered in the "Medications Needed" field below, and please check our website to see if we have the medication you need. If you need assistance filling out this form or would like information for enrollment in our “Fill the Gap” program, please call us at (314) 627-6160 or 1-877-727-9930.

Please help us reach others in need by sharing this information with your neighbors! Our pharmacy's response to the tornado crisis is making free medications available through both local delivery and mail service.

Note: This form only collects information you provide directly — your details are not captured automatically.

Ready? Let's get started.

* Required 

Step 1: Confirm Eligibility Criteria

Step 2: Patient Information

Step 4: Referral Information

Step 4: Disclosures & Consent to the Program Terms and Conditions

I authorize Rx Outreach to administer the Program in accordance with the Terms and Conditions and to do the following:

1. Use the information I provide in my application to determine my eligibility for the Tornado Medication Relief Program and to administer the Program.
2. Receive, maintain, and review records of the prescriptions I receive through the Program for the purpose of providing medication assistance.
3. Contact my healthcare provider, pharmacy, insurer (if applicable), or other healthcare professionals to verify my prescriptions, medication history, insurance status, or other information necessary to determine eligibility and provide services through the Program.
4. Request additional information or documentation at any time to verify my eligibility, residency, identity, prescription needs, or disaster impact.
5. I certify that I have been directly impacted by the May 16, 2025, St. Louis tornado within the Program's designated service area and that the information I have provided is true and complete to the best of my knowledge. Providing false or misleading information may result in denial or termination of assistance.
6. I understand that the Tornado Medication Relief Program is funded through charitable donations and grant funding. Assistance is subject to available funding, medication inventory, emergency pharmacy waivers, and Program availability and is not guaranteed.
7. I understand that the Program provides up to a 90-day supply of eligible medications as determined by Rx Outreach, applicable laws, emergency pharmacy regulations, medication availability, and my valid prescription. Certain medications may not be eligible for assistance.
8. I understand that submitting an application does not guarantee enrollment or receipt of medication. Rx Outreach reserves the right to determine eligibility and discontinue the Program at any time if funding, emergency authorization, or resources are no longer available.
9. I authorize Rx Outreach to contact me by phone, text message, email, or mail regarding my application, medication orders, delivery information, and other communications related to the Tornado Medication Relief Program.
10. I understand that my personal and health information will be maintained in accordance with applicable federal and state privacy laws and used only for administering the Program or as otherwise required by law.
11. I understand that Rx Outreach does not charge a fee to participate in the Tornado Medication Relief Program. If I paid a third party to assist with my application, those fees were not paid to Rx Outreach.
12. I understand that the authorizations provided in connection with this Program will remain in effect for the duration of my participation and for the period required by applicable law for record retention.

Please Allow at least 2 business days for processing.
Rx Outreach will contact you.

I also understand that I have the right to revoke this authorization at any time by calling 314-627-6139 and mailing a signed written statement of my revocation to the Program. Such a revocation would end my eligibility to participate in the Program. Revoking this authorization will prohibit disclosures after the date written revocation is received, except to the extent that action has been taken in reliance on my authorization. I understand that once medical information about me has been disclosed in reliance upon this Authorization, the information may no longer be protected by federal privacy laws and may be further disclosed. I certify that I have read, understand and will abide by the Program Terms and Conditions. I certify that the information provided in this application is complete and accurate to the best of my knowledge. I understand that Rx Outreach may contact me about this application, the Program, and my prescription via phone, text, email, and/or mail. Message and data rates may apply. You can opt out by calling 314-627-6139. For additional information about how Rx Outreach handles your information, please see Rx Outreach’s privacy notice https://rxoutreach.org/privacy-policy/
. Rx Outreach will not share any patient specific information, including any patient health information or financial information. By submitting this application, I agree to the Program Terms and Conditions.