Step 1 of 2 50% If you are paying more than $50 for your medication, Prescription Relief can help!. This covers 100% of the medication cost, no matter the retail price.How Many Brand Medications Are You Prescribed?*Pick OneOneTwoThreeFourFiveSixEnter Your First Brand Medication Enter A Second Brand Medication Enter A Third Brand Medication How Many People Reside In Your Household?Pick OneOneTwoThreeFourFiveSixWhat is Your Monthly IncomePlease enter a number from 0 to 2400.What is Your Monthly IncomePlease enter a number from 0 to 3100.What is Your Monthly IncomePlease enter a number from 0 to 3600. Save and Continue Later Congratulations! You're Pre-qualifiedYou've been approved for a set price of $35 per month for each medication. Calculate Your Savings Below.Your Current 30-Day CostYour 30-Day Cost with AssistanceYOUR SAVINGS PER MONTH Save and Continue Later This iframe contains the logic required to handle Ajax powered Gravity Forms.