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

Program 1 of 4   Scroll down to see them all.  Updated April 16, 2013 Back | Print Page

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

Pfizer Connection to Care

Provided by:


Pfizer, Inc.
PO Box 66585
St. Louis, MO 63166-6585

TEL: 866-706-2400


ALT PHONE:
FAX: 866-470-1748
 Program Website

Languages Spoken: English, Spanish, Others By Translation Service

Patient assistance
applications

 

Medications

Provera   (medroxyprogesterone acetate)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status May have insurance
Those with Part D Eligible? Yes
Income At or below 200% of FPL, adjusted for household size
Diagnosis/Medical Criteria Not specified
US Residency Required? Must reside in the US, Puerto Rico or the USVI
Obtaining Call or download
Receiving Mailed
Returning Mail or fax
Doctor's Action Complete section, sign
Applicant's Action Complete section, sign, attach proof of income
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe 2-4 weeks
Amount/Supply Not specified
Sent To Lyrica to patient's home, other medications to Doctor's office
Delivery Time Within 4 weeks
Refill Process Doctor needs to go online or call in reorder/refill 855-742-7497
Limit None
Re-application New application, new documentation yearly

Additional Information:

This program has absorbed the medications on the former Wyeth and King PAP programs.Those with insurance may qualify on hardship basis. For Lyrica only: the prescription and a copy of the patient's driver's license or other picture ID must be sent with the application.
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 2 of 4   Scroll down to see them all.  Updated February 15, 2013 Back | Print Page

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

Rx Outreach Medications

Provided by:


Rx Outreach
PO Box 66536
St Louis, MO 63166-6536

TEL: 800-769-3880


ALT PHONE:
FAX: 800-875-6591
 Program Website

Languages Spoken: English

Patient assistance
applications

 

Medications

Provera Tablet 2.5mg, 5mg, 10mg (medroxyprogesterone acetate)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status May have insurance
Those with Part D Eligible? Yes
Income At or below 300% of FPL
Diagnosis/Medical Criteria Not required
US Residency Required? Must reside in the US
Obtaining Call, download or apply online
Receiving Faxed or mailed
Returning Fax or E-Prescribe online
Doctor's Action Give prescription to patient
Applicant's Action Complete section, sign
Decision Communicated Medications sent if accepted. If denied patient and Doctor notified
Decision Timeframe Usually same day
Amount/Supply Varies
Sent To Doctor's office or patient's home
Delivery Time Not specified
Refill Process Company contacts patient to arrange
Limit Only limited by manufacturer's guidelines
Re-application New application yearly

Additional Information:

Some medications are available for a fee of $20 for up to a 180 day supply.
Check the website for the exact price.
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 3 of 4   Scroll down to see them all.  Updated January 14, 2013 Back | Print Page

This is a discount card program.

Together Rx Access

Provided by:


Together Rx Access, LLC
One Outlet Lane
Bald Eagle Court
Lock Haven, PA 17745

TEL: 800-444-4106


ALT PHONE:
FAX:
Program Website

Languages Spoken: English, Spanish

Patient assistance
applications

 

Medications

Provera Tablet 2.5mg, 5mg, 10mg (medroxyprogesterone acetate)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must have no prescription coverage
Those with Part D Eligible? No, must be ineligible
Income At or below $45,000 if single, $60,000 for family of 2, $75000 for 3, $90,000 for4, $105,000 for 5
Diagnosis/Medical Criteria Not specified
US Residency Required? Not specified
Obtaining Enroll online
Receiving Downloaded from website
Returning Mail
Doctor's Action Not applicable
Applicant's Action If eligible, respond to 4 questions to enroll
Decision Communicated Patient notified
Decision Timeframe Not applicable
Amount/Supply Not applicable
Sent To Patient sent savings card to be used at pharmacy
Delivery Time Not applicable
Refill Process Not applicable
Limit Not applicable
Re-application Not applicable

Additional Information:

The patient must not be eligible for Medicare. Most cardholders save between 25%-40% on brand name prescription medications.

Call for most recent medications as the list is subject to change.
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 4 of 4.  Updated April 30, 2013 Back | Print Page

This is a discount card program.

Pfizer Pfriends

Provided by:


Pfizer, Inc.
PO Box 66543
St Louis, MO 63133

TEL: 866-706-2400


ALT PHONE:
FAX:
Program Website

Languages Spoken: English, Spanish, Others By Translation Service

Patient assistance
applications

 

Medications

Provera   (medroxyprogesterone acetate)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must be uninsured
Those with Part D Eligible? No
Income Not disclosed
Diagnosis/Medical Criteria Not specified
US Residency Required? Must reside in the US, Puerto Rico or the USVI
Obtaining Call or download
Receiving Faxed or mailed
Returning Mail
Doctor's Action Give prescription to patient
Applicant's Action Complete
Decision Communicated Patient notified in writing
Decision Timeframe 2-4 weeks
Amount/Supply Not applicable
Sent To Patient sent card to be used at pharmacy
Delivery Time Card shipped within 3 weeks
Refill Process Patient presents voucher/card to pharmacy for each refill
Limit None
Re-application Patient contacts company

Additional Information:

The Pfizer Pfriends savings program is not health insurance.



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