Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
 

Chantix

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Pfizer RxPathways Patient Assistance Program

This program provides brand name medications at no or low cost.

Provided by: Pfizer, Inc.

PO Box 66585
St. Louis, MO 63166-6585

TEL: 866-706-2400


FAX: 866-470-1748
Languages Spoken:

English, Spanish

Program Website

 

Program Applications and Forms

Pfizer Group A Application for Primary Care Medicines

Pfizer Group A Application for Primary Care Medicines (Spanish)

Pfizer Group B Application for Oncology and Specialty medicines

Pfizer Group B Application for Oncology and Specialty medicines (Spanish)

Pfizer Group C Application for Vaccines

Pfizer Group C Application for Vaccines (Spanish)

 

Medications

  • Chantix tablet (varenicline tartrate)
 

Eligibility Requirements   

Insurance Status Uninsured or Underinsured
Those with Part D Eligible? Yes
Income Varies
Diagnosis/Medical Criteria Not specified
US Residency Required? Must reside in the US, Puerto Rico or the USVI
   

Application

Obtaining Call or download
Receiving Mailed or downloaded from website
Returning Fax or mail
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Patient and Doctor are notified
Decision Timeframe Varies
   

Medication

Amount/Supply Varies
Sent To Varies
Delivery Time Varies
Refill Process Varies per medication
Limit None
Re-application New application, new documentation yearly
   

Additional Information

This program also offers a savings program, insurance counseling, and other support services. Contact Program for details.


Updated November 05, 2015