Apply Now

Visit our portal page to begin your application today! It includes some easy to follow questions and the opportunity to submit your documents.

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    MedAssist staff will review your complete application and assign a grant value based on three (3) factors.

    • Total Annual Household Gross Income (Percent of Federal Poverty Level (FPL))
    • ­Estimate total household out-of-pocket healthcare expenses from the previous calendar year
    • Medication Category (Diabetes Medication, Asthma Inhaler, Epinephrine Auto-injector)

    Yes, please see details by visiting the “Appeals” page on the left sidebar.

    Yes, you will need to create a new account to submit an application for MedAssist through the online portal. All you need is a valid email address to create your account.

    You may continue to receive benefit from the MedAssist program while you meet the eligibility criteria and funding is available. 

    Yes, health insurance is not a program eligibility requirement.

    After your application is approved, you will be given instruction on how to provide the banking information.


    • Insulin glulisine (Apidra®)
    • Insulin aspart (Novolog®)
    • Insulin lispro (Humalog®)
    • Regular insulin (Novolin R, Humulin R)
    • NPH insulin (Novolin N, Humulin N)
    • Insulin detemir (Levemir®)
    • Insulin glargine U-100 (Lantus®, Basaglar®)
    • Insulin glargine U-300 (Toujeo®)
    • Insulin degludec U-100/U-200 (Tresiba®)
    • Humalog® mix 75/25
    • Humalog® mix 50/50
    • Novolog® mix 70/30
    • Metformin (Glucophage)
    • Glimepiride(Amaryl)
    • Glipizide (Glucotrol)
    • Glyburide (Diabeta)
    • Pioglitazone (Actos)
    • Linagliptin (Trajenta)
    • Sitagliptin (Januvia)
    • Dapagliflozin (Farxiga)
    • Empagliflozin (Jardiance)
    • Dulaglutide (Trulicity)
    • Semaglutide (Ozempic, Rybelsus)
    • Liraglutide (Victoza)


    Asthma inhalers include but are not limited to the following list:

    • Albuterol (ProAir®, Ventolin®)
    • Levalbuterol (Xopenex®)
    • Fluticasone (Flovent®)
    • Budesonide (Pulmicort®)
    • Mometasone (Asmanex®)
    • Beclomethasone (QVAR®)
    • Fluticasone and salmeterol (Advair Diskus®)
    • Budesonide and formoterol (Symbicort®)
    • Mometasone and formoterol (Dulera®)
    • Fluticasone and vilanterol (Breo Ellipta®)
    • Salmeterol (Serevent Diskus®)

    • EpiPen® and EpiPen Jr®
    • SYMJEPI® pre-filled epinephrine syringe
    • Generic epinephrine auto-injector

    No, your rank of the waitlist is determined by the date and time your application was complete. Applications are approved from the waitlist on a first-come-first-served basis as funding becomes available.

    Yes. All information you provide is held in the strictest confidence. Only authorized employees and official representatives of a program or agency providing services have access to your information. Federal confidentiality rules apply to your application and documents.

    If your information has changed – you will need to contact the MedAssist Team. You must notify us if any of the following information has changed:

    Personal Information, Household, Job Status and Income


    We're Here to Help You Every Step of the Way!

    Don’t let some simple paperwork get in your way of getting money back. In person application assistance is available.

    Reach out to us
    Please call (408) 970-2001 to make an appointment. We are open Monday - Friday, 9:00am - 5:00pm.
    Our office address is:
    Santa Clara Valley Health
    777 Turner Dr
    San Jose, CA 95128

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    Learn More About MedAssist

    Ready to learn more about how our money back program can benefit you? Dive deeper into the program by exploring our website and discovering all the ways we can help you earn cash back. Don't miss out on this opportunity to save money and protect your health.

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    Approval Process

    Curious about how the approval process works for MedAssist? Read on for more information about what to expect.

    Follow Along

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    We have all the necessary forms ready for you to print. Visit our forms page for everything you need.

    Stay Organized

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    Contact Us

    Don't hesitate to visit our contact us page and reach out to our team for assistance.

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