Do you know a person or family that desperately needs help paying for their prescription drugs? If you are a Simple Savings Card user, you can nominate a card user (including yourself) to receive 3 months of free prescriptions.* We offer this ongoing program because we understand the high cost of prescription drugs and want to provide extra help for those that may be in a difficult situation.

1. All nominees will need to have used the Simple Savings Card for at least 30 days to establish the monthly cost of their prescriptions. If you need to request a card for yourself or for someone else, you can do so here. Request a card.

2. Download and complete the application.

You will need Adobe Reader to print this application.

3. Mail your application and photograph(s) to:

Luscinia Health | Simple Savings Card
c/o 3 Months Free
5629 FM 1960 W, Suite 234
Houston, Tx 77069

4. Our goal is help those that need help the most. Please understand we DO NOT respond to all applications, and we do not return photographs or applications. Please do not send anything with sentimental value.

Dora - Post, TX	Lesley - Plano, IL	Shirley-Pine City, MN	Charles - Dayton, OH	Emily - Ruffin, NC

* The amount awarded to selected applicants will be equal to 3 times the total dollar amount of prescription drug purchases made within a given 30-day period using the Simple Savings Card. The maximum award amount is $300.