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 30, 2013 Back | Print Page

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

Pfizer RSVP Program

Provided by:


Pfizer, Inc.
PO Box 220574
Charlotte, NC 28222-0574

TEL: 888-327-7787


ALT PHONE:
FAX: 888-773-0121
 Program Website

Languages Spoken: English, Spanish, Others By Translation Service

Patient assistance
applications

 

Medications

sildenafil Tablet 20mg/ml (Revatio)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must be uninsured or underinsured
Those with Part D Eligible? Yes
Income Not disclosed
Diagnosis/Medical Criteria Not specified
US Residency Required? Yes
Obtaining Call for prescreening
Receiving Sent to doctor or patient
Returning Mail or fax
Doctor's Action Complete section, sign, attach prescription
Applicant's Action Complete section, sign
Decision Communicated Patient and Doctor notified of acceptance
Decision Timeframe Within 24-48 hours
Amount/Supply Varies
Sent To Doctor's office or patient's home
Delivery Time Within 10 days
Refill Process Company contacts patient to arrange
Limit Not applicable
Re-application New application, new documentation yearly

Additional Information:

Insurance benefits, claims assistance and/or other reimbursement help is offered.
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 April 30, 2013 Back | Print Page

This is a copay assistance program.

Pfizer RSVP Co-Pay Program

Provided by:


Pfizer, Inc.
PO Box 220574
Charlotte, NC 28222-0574

TEL: 888-327-7787


ALT PHONE:
FAX: 888-773-0121
 Program Website

Languages Spoken: English, Spanish, Others By Translation Service

Patient assistance
applications


 

Medications

sildenafil Tablet 20mg/ml (Revatio)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must not have public insurance, may have private insurance
Those with Part D Eligible? No
Income Not disclosed
Diagnosis/Medical Criteria Not specified
US Residency Required? MA residents are not eligible
Obtaining Call for prescreening
Receiving Sent to Doctor's office
Returning Mail or fax
Doctor's Action Complete section, sign, attach prescription
Applicant's Action Complete section, sign
Decision Communicated Patient and Doctor are notified
Decision Timeframe Within 24-48 hours
Amount/Supply Varies
Sent To Patient sent card to be used at pharmacy
Delivery Time ID number given over the phone or card shipped within 7-10 business days
Refill Process Patient presents voucher/card to pharmacy for each refill
Limit Not specified
Re-application Must re-enroll at end of calendar year

Additional Information:

The program will cover co-pay costs up to $7,500 for the medication Revatio, and up to $10,000 for the medications Xyntha and Benefix.
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

sildenafil Tablet 25mg, 50mg, 100mg (Viagra)

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

sildenafil   (Revatio)

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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