Prescription Advantage Application

Things to note before you start completing this application:

  • Prescription Advantage is only available to those with a primary residence in Massachusetts. A primary residence is one in which you reside for at least six (6) months during the calendar year.
  • If you and your spouse are both applying, you must each fill out a separate application.
  • Information to have on hand while completing this application: Applicant Date of Birth, Medicare ID number and current Part D plan name, if applicable.
  • Any item followed by an * is required information. You must provide this information before you can continue on to the next page.
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Applicant Information
Male   FeMale
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