ZUBSOLV Patient Assistance Program - NeedyMeds - needymeds 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out your personal information on page 1, including your name, address, phone number, and email. Ensure all fields are completed accurately.
3. Proceed to the eligibility section. Indicate your residency status and provide your annual household income. Attach the required documentation based on your application timing.
4. In the medical questions section, list any medications you are currently taking and any allergies you may have. If none, check the appropriate boxes.
5. Sign and date the application at the end of page 2. Remember to attach a copy of your valid driver’s license or state photo ID.
6. Have your prescriber complete page 3 of the application, including their signature and prescription for ZUBSOLV.
7. Finally, submit the completed application either by faxing it or mailing it to the provided address.

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