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Patient Assistance Information

 
 
 
Pfizer RxPathways Patient Assistance Program

PO Box 66585
St. Louis, MO 63166-6585
Phone : (866)706-2400
Fax: (866)470-1748
Eligibility
> 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
> Anyone who has been prescribed a Pfizer medicine and is in need of assistance can call or download an application.
Required
> The doctor must fill out a section and sign. The patient must fill out a section, sign the application and attach proof of income.
Supply
> Varies
Ship To
> Varies
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.
 
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
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
Download printable Form
Download printable Form
Download printable Form
Download printable Form
Download printable Form
(Requires Acrobat Reader