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Pfizer RxPathways Patient Assistance Program
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PO Box 66585
St. Louis, MO 63166-6585
Phone
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(866)706-2400
Fax:
(866)470-1748
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Eligibility
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The patient must either have no prescription coverage, or not enough coverage, to pay for their prescribed Pfizer medicine(s). Income requirements for this program have not been disclosed. Patients must reside in the US, Puerto Rico or USVI. |
| Who Can Apply
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Anyone who has been prescribed a Pfizer medicine and is in need of assistance can call or download an application. |
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Required
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The doctor must fill out a section and sign. The patient must fill out a section, sign the application and attach proof of income. |
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Supply
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Varies |
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Ship To
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Varies |
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Note
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| Aromasin |
| Arthrotec Tablets (diclofenac sodium/misoprostol) |
| Benefix injection |
| Bosulif (bosutinib) tablets |
| Caduet Tablets |
| Camptosar |
| Caverject Injection (alprostadil) |
| Celebrex Capsules |
| Celontin Capsules |
| Chantix |
| Cleocin Capsules |
| Cleocin Pediatric Oral Suspension |
| Cleocin Phosphate injection |
| Cleocin T lotion; topical |
| Cleocin T solution; topical |
| Colestid Granules |
| Colestid Tablets |
| Depo SubQ Provera Injection |
| Depo-Estradiol Injection |
| Depo-Medrol Injection |
| Detrol LA Capsules |
| Detrol Tablets |
| Dilantin capsule; extended release |
| Dilantin Capsules |
| Dilantin tablet; chewable |
| Dilantin-125 oral suspension |
| Duavee tablet |
| Effexor XR capsule; extended release |
| Ellence Injection |
| Emcyt capsule |
| Estring Vaginal Ring |
| Glyset Tablets |
| Ibrance |
| Idamycin PFS injection |
| Inlyta tablet |
| Inspra Tablets |
| Lincocin injection |
| Lyrica Capsules |
| Mycobutin Tablets (rifabutin) |
| Nardil Tablets |
| Nicotrol Inhaler |
| Nitrostat tablet |
| Norpace Capsules |
| Premarin cream; vaginal |
| Premarin tablet |
| Premphase tablet |
| Prempro tablet |
| Prevnar 13 vaccine |
| Pristiq tablet; extended release |
| Procardia Capsules |
| Procardia XL Capsules (Nifedipine) |
| Quillivant XR suspension; extended release |
| Rapamune oral solution |
| Rapamune tablet |
| Relpax Tablets |
| Revatio tablet |
| Skelaxin (metaxalone) |
| Sutent Capsule |
| Synarel Nasal Spray |
| Tikosyn Tablets (dofetilide) |
| Torisel solution; iv |
| Toviaz tablet; extended release |
| Trecator tablet |
| Vantin Oral Solution (cefpodoxime proxetil) |
| Vfend |
| Viagra Tablets |
| Xalatan |
| Xalkori capsule |
| Xyntha Solofuse iv |
| Zarontin |
| Zinecard injection |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form |
| Download printable Form |
| Download printable Form |
| Download printable Form |
| Download printable Form |
| Download printable Form |
(Requires Acrobat Reader) 
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Pfizer Bridge Program
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P.O. Box 220746
Charlotte, NC 28222
Phone
:
800-645-1280
Fax:
800-479-2562
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Eligibility
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The patient must be uninsured or underinsured and meet income guidelines that are not disclosed. The medication must be used for a FDA-approved diagnosis.The patient must also be a US resident. |
| Who Can Apply
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With the patient's permission, anyone concerned can call for an application. |
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Required
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The doctor must complete and sign the Statement of Medical Necessity Form. The patient must complete and sign the application and the Patient Authorization Form. |
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Supply
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Up to a 30-day supply |
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Ship To
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Patient's home |
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Note
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With the patient's permission, anyone concerned can call for an application. |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| Genotropin |
| Somavert injection |
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Lipitor Choice Co-Pay Program
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LIPITOR Choice Card
14001 Weston Parkway, Suite 103
Cary, NC 27513
Phone
:
800-314-7957
Fax:
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Eligibility
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This is a copay assistance program for patients that have private insurance. Patients with government funded insurance are not eligible. Patient with Medicare Part D are eligible but must contact the program for details. There are no income requirements for this program. MA residents are not eligible. |
| Who Can Apply
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Patients or healthcare providers can call to complete by phone or complete online. |
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Required
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Patients must enroll online or by phone and doctors must provide a prescription. |
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Supply
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Not applicable |
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Ship To
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Patient sent card to be used at pharmacy |
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Note
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Program expires 12/31/16
This card is only valid at participating pharmacies.
The maximum savings is $2500 per year.
To qualify for this offer your out-of-pocket expense must be more than $4 per prescription. |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| Lipitor Tablets |
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Xelsource Answers and Support for Xeljanz
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2730 S. Edmonds Lane, Suite 300,
Lewisville, TX 75067
Phone
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855-493-5526
Fax:
866-297-3471
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Eligibility
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Patients must be uninsured or underinsured. Medicare Part D recipients are also eligible. Income requirements for this program vary. Patients must live in the US. |
| Who Can Apply
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Patients or healthcare professionals can call to have an application mailed or download the application. |
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Required
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Doctors must complete a section of the application and sign. Patients must complete a section of the application, sign and attach proof of income. |
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Supply
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Varies |
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Ship To
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Varies |
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Note
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|
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| Xeljanz tablet |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
|
| Download printable Form |
| Download printable Form |
| Download printable Form |
| (Requires Acrobat Reader)
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