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Patient Assistance Information

 
2 Programs for VFEND Filmtab
 
 
Pfizer Pfriends

PO Box 66543
St. Louis, MO 63166
Phone :
Fax: Not Applicable
Eligibility
> The patient must have been prescribed a Pfizer medicine, have no prescription insurance, and reside in the US, USVI, or Puerto Rico. There are no income requirements for the program.
Who Can Apply
> Anyone in need of assistance can call to apply, or can download an application online and sumit to the program.
Required
> The doctor needs to provide a prescription to the patient.The patient must either apply over the phone or submit an application form.
Supply
> Eligible patients will be sent a Pfizer Pfriends savings card that can be used at over 95% of pharmacies in the US. When filling their Pfizer prescription, patients simply present the Pfizer Pfriends card to their pharmacist to receive immediate savings.
Ship To
> Savings Card is shipped to the patient's home; medicine can be retreived with the savings card at the pharmacy.
Note
>
 
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.
 
VFEND Filmtab
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Pfizer Pfriends Application
Download printable Form Pfizer Pfriends Application-Spanish
(Requires Acrobat Reader
 
 
Together Rx Access

PO Box 9426
Wilmington, DE 19809-9944
Phone : 800-444-4106
Fax:
Eligibility
> The patient must have no insurance and have an income at or below $30,000 for an individual ($60,000 for a family of four) The patient must also be a US resident.
Who Can Apply
> The patient can call to get an application, apply on line, or download the application.
Required
> Eligible people simply respond to four questions to enroll.
Supply
> Together Rx Access prescription savings card.
Ship To
> Patient's home
Note
> The patient can call to get an application, apply on line, or download the application.
 
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.
 
VFEND Filmtab
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader