866-706-2400

The patient must have no prescription coverage for any medications and and have an income at or below 200% of the Federal Poverty Level, adjusted for family size. Medical diagnosis necessary for this program is not specified. The patient must also reside in the US.  If a patient has insurance, including Medicare Part D,meets the income guidelines and has a prescription to a medication on this program and cannot afford the co-pay due to extreme medical or financial hardship, s/he may qualify to get assistance and should call the program. For Lyrica only: the prescription for Lyrica, as well as a copy of the patient's driver's license or other picture ID must be sent with the application. Please note, Lopid is on back order and will be added back to the program when it is available.

Anyone requesting assistance can call the above number to request an application be mailed or faxed out or download it from the website. The application can be faxed, mailed out or downloaded from website. The completed application must be mailed back.  Both the patient and the health care professional are notified in writing of acceptance or denial.  Allow 4 weeks for processing and delivery of medication.

The doctor must fill out a section and sign the application. The patient must fill out a section, sign the application and attach proof of income.

Up to a 90 day supply is sent to the doctor's office, except for Lyrica which is sent to the patient's home. The doctor can refill prescriptions or add new Pfizer medicines by calling 866-706-2400. Once a year a new application with financial documentation is needed.