For Individuals

DITCH THE COST. DITCH THE WEIGHT. DITCH THE STRESS. 

For a low, one time fee* you and your family can buy into a lifetime** of savings. Get medication delivered directly to your door without having to worry about renewing your subscription or recurring payments. Save the stress of paying every year for a Prescription Savings Club. Our Pharmacy Members get all their meds for discount prices. Pick your meds up in person, or add a small shipping fee for delivery.***.

This is NOT a recurring fee. This is a ONE TIME fee. Currently, the one time fee is $99.99.

Use the signup form below to get started!

Signup For An Individual Plan

• Individual
  $99.99

  INDIVIDUAL

  One low price gets you discount meds for life!

  • Everything in FREE plan PLUS:
    • Deep discounts on prescription medications
    • Rx 2 Go App allows you to get refills

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Sign Up For Pill Pals

*

Choose A Username

* Choose A Username

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*

Create A Password (at least 12 characters, one Uppercase letter, one Number, and one Special Character)

* Create A Password (at least 12 characters, one Uppercase letter, one Number, and one Special Character)

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Strength: Very Weak

*

Confirm Password

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Email Address

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First Name

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Middle Name

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Last Name

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Date of Birth (DD/MM/YYYY) For example, December 25, 2021 is 25/12/2021

* Date of Birth (DD/MM/YYYY) For example, December 25, 2021 is 25/12/2021

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Race / Ethnicity - Please provide us with this information so that we can manage your care. Some drugs may have variable effects in different racial/ethnic groups.

Caucasian / WhiteBlack / African AmericanAmerican Indian / Alaska NativeHispanic / LatinoAsianNative Hawaiian or Other Pacific Islander

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*

Biological Gender

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Are you currently pregnant?

YesNo

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If YES, when is your due date? (DD/MM/YYYY) For example, December 25, 2021 is 25/12/2021

If YES, when is your due date? (DD/MM/YYYY) For example, December 25, 2021 is 25/12/2021

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*

Do you have any allergies?

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If YES, please list all allergies below:

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Preferred Language (e.g. English)

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Country / Region

* Country / RegionCountry/RegionAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongoCosta RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceFrench GuianaFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe

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Address Line 1

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Address Line 2

Address Line 2

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City

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State / Region

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Zip / Postal Code

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Were you referred by a friend? Enter their Name and Email Address below:

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Agree To The Terms

I Agree

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By checking the box above, I am indicating that I agree to the Privacy Policy and Terms of Use of the Pill Pals website. In addition, I have read the Electronic Signature Consent Statement, HIPAA Authorization & Disclosure, and Disclaimer pages.

Done

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Select Your Payment Method

• Credit Card / Debit Card / Google Pay
• PayPal

How you want to pay?

 Auto Debit Payment

 Manual Payment

Payment Summary

Your currently selected plan : , Plan Amount :

Coupon Discount Amount : , Final Payable Amount:

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* Fee is “per patient”

** For the life of the company or the patient; whichever comes first. Minimum 5 years of operation.

** Price + Handling and/or Shipping