| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 1 of 3. Scroll down to see them all. |
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HealthWell Foundation Copay ProgramThis is a copay assistance program |
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Provided by: HealthWell Foundation |
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PO Box 220410 TEL: 800-675-8416FAX: 800-282-7692 |
Languages Spoken:
English, Others By Translation Service |
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Program Applications and Forms |
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HealthWell Foundation Copay Program: Contact program |
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Medications |
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Eligibility Requirements |
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| Insurance Status | May have insurance | ||
| Those with Part D Eligible? | Yes | ||
| Income | Varies | ||
| Diagnosis/Medical Criteria | Medically appropriate condition/diagnosis | ||
| US Residency Required? | Must reside in the US | ||
Application |
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| Obtaining | Call or complete online | ||
| Receiving | Sent out or may be completed online | ||
| Returning | |||
| Doctor's Action | Complete section and sign | ||
| Applicant's Action | Complete section, sign, attach a copy of proof of income | ||
| Decision Communicated | Patient notified in writing | ||
| Decision Timeframe | 3-5 business days | ||
Medication |
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| Amount/Supply | Not applicable | ||
| Sent To | Varies | ||
| Delivery Time | Not specified | ||
| Refill Process | Good for one year | ||
| Limit | Not specified | ||
| Re-application | New application every 12 months | ||
Additional Information |
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| This program provides financial assistance to eligible individuals to cover coinsurance, copayments, healthcare premiums and deductibles for certain treatments. Also, for those who are eligible for health insurance, but cannot afford the insurance premium, the foundation may be able to help by paying some or all of the medical portion of insurance premiums. The patient is being treated for a specific disease for which funding is available and has insurance that covers the treatment for this disease. Call for most recent medications as the list is subject to change. |
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| Updated May 22, 2017 | |||
| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 2 of 3. Scroll down to see them all. |
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Patient Access Network Foundation (PAN)This is a copay assistance program |
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Provided by: Patient Access Network Foundation |
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PO Box 221858 TEL: 866-316-7263FAX: 866-316-7261 |
Languages Spoken:
English, Spanish, Others By Translation Service |
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Program Applications and Forms |
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Patient Access Network Foundation (PAN) Application: Contact program |
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Medications |
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Eligibility Requirements |
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| Insurance Status | *See Additional Information section below | ||
| Those with Part D Eligible? | Determined case by case | ||
| Income | Between 400-500% of FPL | ||
| Diagnosis/Medical Criteria | Medically appropriate condition/diagnosis | ||
| US Residency Required? | Must reside and receive treatment in US | ||
Application |
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| Obtaining | Call or complete online | ||
| Receiving | Complete online or by phone | ||
| Returning | Complete online or by phone | ||
| Doctor's Action | Will be discussed with patient and Doctor after request is received | ||
| Applicant's Action | Call for information or inform doctor that he/she is in need | ||
| Decision Communicated | Patient and Doctor notified in writing | ||
| Decision Timeframe | Within 48 hours | ||
Medication |
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| Amount/Supply | Not applicable | ||
| Sent To | Patient sent card to be used at pharmacy | ||
| Delivery Time | Once approved; shipped same day | ||
| Refill Process | Patient presents voucher/card to pharmacy for each refill | ||
| Limit | None | ||
| Re-application | New application every 12 months | ||
Additional Information |
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| *Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance. Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly. Note: All new enrollment is now done electronically or over the phone. Contact program for details. |
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| Updated June 29, 2017 | |||
| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 3 of 3. | |||
Pfizer Savings Program |
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Provided by: Pfizer, Inc. |
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PO Box 66585 TEL: 866-706-2400FAX: 866-470-1748 |
Languages Spoken:
English |
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Program Applications and Forms |
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Pfizer Savings Program Medication List |
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Medications |
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Eligibility Requirements |
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| Insurance Status | Must be uninsured | ||
| Those with Part D Eligible? | No | ||
| Income | Varies | ||
| Diagnosis/Medical Criteria | Not specified | ||
| US Residency Required? | Must be residing in the US or US territory | ||
Application |
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| Obtaining | Call for prescreening | ||
| Receiving | There is no application | ||
| Returning | Not applicable | ||
| Doctor's Action | Give prescription to patient | ||
| Applicant's Action | Call to enroll | ||
| Decision Communicated | Decision made during phone screening | ||
| Decision Timeframe | Decision made during phone screening | ||
Medication |
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| Amount/Supply | Contact the program for more details. | ||
| Sent To | Pharmacy | ||
| Delivery Time | Not applicable | ||
| Refill Process | Varies per medication | ||
| Limit | None | ||
| Re-application | New enrollment every 12 months | ||
Additional Information |
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| This program provides uninsured patients with savings on their prescriptions at the pharmacy. Pfizer also has programs that provide eligible patients with insurance support, copay assistance, and medicines for free. Contact Pfizer RxPathways for details (844-989-7284) |
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| Updated August 18, 2017 | |||
