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Program 1 of 4.
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Updated April 14, 2014

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


ALT PHONE:
FAX: 866-470-1748
Languages Spoken:

English, Spanish

Program Website
 

Patient Assistance Applications

Pfizer Group A Application for Primary Care medicines

Pfizer Group B Application for Oncology and Specialty medicines

Pfizer Group C Application for Vaccines

Pfizer Group A Application for Primary Care medicines (Spanish)

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

Pfizer Group C Application for Vaccines (Spanish)

 

Medications

  • hydrocortisone Tablet dosage varies (Cortef)
 

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 Mail or fax
Doctor's Action Complete section, sign
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe Within 4 weeks
   

Medication

Amount/Supply Varies
Sent To Address of shipment varies by medication *See Additional Information section below
Delivery Time Within 2-4 weeks
Refill Process Patient or Doctor must contact company
Limit None
Re-application New application, new documentation yearly
   

Additional Information

*Lyrica, oral oncology, and specialty products are shipped to the patient's home, other medications to Doctor's office

For help with Prevnar 13, please contact customer service and talk to your health care provider. This program was formerly known as Pfizer Helpful Answers



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

Program 2 of 4.
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Updated April 04, 2014

Arbor Patient Assistance Program

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

Provided by: Arbor Pharmaceuticals, LLC.

951 Clint Moore Road
Suite A
Boca Raton, FL 33487

TEL: 888-417-7153


ALT PHONE:
FAX: 407-641-9566
Languages Spoken:

English

Program Website
 

Patient Assistance Applications

Arbor Patient Assistance Program Application

 

Medications

  • hydrocortisone Lotion 2% (Pediaderm HC)
 

Eligibility Requirements

Insurance Status Must be uninsured or underinsured
Those with Part D Eligible? Yes, but have been denied or are ineligible for Low Income Subsidy
Income At or below 300% of FPL
Diagnosis/Medical Criteria Medically appropriate condition
US Residency Required? Yes
   

Application

Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Mail or fax
Doctor's Action Complete section, sign, attach prescription
Applicant's Action Complete section, sign, attach proof of income and include Medicaid denial letter
Decision Communicated Patient and Doctor are notified
Decision Timeframe 2-4 weeks
   

Medication

Amount/Supply Up to 90 day supply
Sent To Doctor's office
Delivery Time Within 5-7 business days
Refill Process Patient needs to contact company
Limit None
Re-application New application yearly
   

Additional Information

Must be at or below 300% FPL for BiDil.
Must be at or below 200% FPL for all other medications.



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

Program 3 of 4.
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Updated February 18, 2014

Salix Pharmaceuticals Patient Assistance Program

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

Provided by: Salix Pharmaceuticals

PO Box 66520
St Louis MO 63166-6520

TEL: 866-282-6563


ALT PHONE:
FAX: 877-738-3694
Languages Spoken:

English, Others By Translation Service

Program Website
 

Patient Assistance Applications

Salix Pharmaceuticals Patient Assistance Program Application

Fulyzaq Patient Assistance Program Application

Xifaxan 550 Patient Assistance Program Application

 

Medications

  • hydrocortisone  Cream 1% (Proctocort)
  • hydrocortisone  Cream 2.5% (Anusol-HC)
 

Eligibility Requirements

Insurance Status Must have no prescription coverage
Those with Part D Eligible? No
Income At or below 200% of FPL
Diagnosis/Medical Criteria Medically appropriate condition
US Residency Required? Must have a verifiable US or US territory address (no PO Box)
   

Application

Obtaining Call or download
Receiving Sent to doctor or patient
Returning Mail
Doctor's Action Complete section, sign
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Medications sent if accepted. If denied patient and Doctor notified
Decision Timeframe Within 2 weeks
   

Medication

Amount/Supply 90 day supply with up to 3 refills, for a total of up to 1 year of medications
Sent To Patient's home
Delivery Time Within 2 weeks
Refill Process Refill/reorder form included with shipment
Limit None
Re-application New application yearly
   

Additional Information

Must be at or below 500% FPL for Fulyzaq and Xifaxin.

Contact program for Spanish application.



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

Program 4 of 4. Updated April 14, 2014

Pfizer RxPathways Savings Card

This is a discount card program.

Provided by: Pfizer, Inc.


TEL: 866-706-2400


ALT PHONE:
FAX:
Languages Spoken:

English

Program Website
 

Patient Assistance Applications

 Pfizer RxPathways Savings Card: Contact program

 

Medications

  • hydrocortisone Tablet dosage varies (Cortef)
 

Eligibility Requirements

Insurance Status Must have no prescription coverage
Those with Part D Eligible? No
Income Not Required
Diagnosis/Medical Criteria Medically appropriate condition
US Residency Required? Must reside in the US, Puerto Rico or the USVI
   

Application

Obtaining No application
Receiving Not applicable
Returning Not applicable
Doctor's Action Give prescription to patient
Applicant's Action Call to enroll
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply Not applicable
Sent To Card sent to doctor's office or to patient's home
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
Re-application Not specified
   

Additional Information