Hardship Letter Medication Cost

{Your Name}
{Your Address}
{Your Phone #}

{Date}

Dear {Drug Representative}:

I am writing to request a discount of {percentage} on {medication}.

For the last {amount of time} I have been on {medication}, which I require for {condition}. This is a life-threatening condition, and if I do not take this medication every {frequency}, {consequence} will occur.

As you know, {medication} increased in price from {price} to {price} over the course of {amount of time}. This price is one that I can no longer afford, as you can see from the {pay stubs, bank receipts} that I have attached to this letter.

I am still capable of paying {price} per {amount}, and I would like to ask that that price remain what I am charged.

Thank you for your time and consideration. Please feel free to contact me at {contact information}.

Thank you,

{Sender Name}

Index of Hardship Letter Examples