BTA Application & Patient Attestation Form
As a 501(c)3 non-profit medical practice, Amity Medical Group, Inc is offering limited medication copay assistance through charitable funds provided through our collaborative relationship with our contract pharmacy. Amity Medical Group, Inc does not discriminate based on income level or socioeconomic status because there are many personal reasons that people cannot afford their copays even when they are insured (special circumstances, high deductibles, high copays, and more). By no means should assistance through this program ever be considered “free medications” or “free copays”. This program is providing assistance paying for care until the patient’s situation changes and they are no longer in need of financial assistance. This program is the payer of last resort if all other resources for the patient have been exhausted.