Program Overview Get Started Pharmacy InformationPharmacy Name*Email* DIR Fee Insurance: UnderwritingPlease supply your past 3 months dispensing data in CSV or Excel Format. Drop files here or This will be utilized for underwriting & risk analysis. Data needed: Drug Name, NDC, Dose, Quantity & Date Range. APPA cares deeply about the privacy & security of your data. View our Data Privacy Policy.File Transfer Alternative: Share a LinkIf you receive an error utilizing the file upload system above, please provide a dropbox or other file sharing link here. Cost Savings AnalysisTo ensure our schedule of approved & insured products does not impact your cost of goods, please provide the following information:Are you currently using SureCost?*YesNoPricingSpecialty: Invoice WAC*Speciality Rebate*Brand: Invoice WAC*Brand Rebate*Generic: Invoice Total*Generic Rebate*BlendSpecialty Volume*Brand Volume*Generic Volume*Do you participate in a 340B Program?*YesNoPatient EngagementHow do you currently deliver product?*Mark All That Apply In-store Mail Order Closed Door Delivery If Delivery, please provide radius from store location:Prescriber Engagement & Clinical ServicesCurrent Professional & Commercial Insurance Company: (Pharmacist Mutual, etc)*Number of Prescribers*Patient Population Size*PhoneThis field is for validation purposes and should be left unchanged.
