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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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