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Patient Assistance Information

 
1 Program for Somavert injection
 
 
Pfizer Bridge Program

P.O. Box 220746
Charlotte, NC 28222
Phone : 800-645-1280
Fax: 800-479-2562
Eligibility
> 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
> With the patient's permission, anyone concerned can call for an application.
Required
> 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.
Supply
> Up to a 30-day supply
Ship To
> Patient's home
Note
> With the patient's permission, anyone concerned can call for an 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.
 
Somavert injection