800-707-8990

The patient must not have any private nor public insurance 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 is eligible for Medicare Part D but did not enroll then s/he may still be eligible for this program. If a patient has insurance, 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 could get assistance and should call the program. A Hardship Form is now available and should be sent with the new patient application. Healthcare providers can request expedited delivery of some medications. Call to request an Expedited Product Order form and the list of medications. Lopid is on backorder as of 10/30/09 and applications requesting this medication may be returned. Call the Pfizer program first prior to applying for an update.

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 will be faxed out. The completed application must be mailed back.  Both the patient and doctor are notified in writing of acceptance or denial.  Allow 4 weeks for processing and delivery of medication.

The doctor must fill out a section, sign the application and attach a prescription. 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 800-707-8990. Once a year a new application with financial documentation is needed.