Tips for using the applications:
- You will need Adobe Reader to open the applications. Download this free program or the latest version, which is recommended.
- Click the button in the top right of the application to turn on the Highlight Fields Option which will highlight the fields to be filled out.
- Use the "tab" key to easily go to the next field.
As of 07/15/2018 there are 584 applications available.
Click on the first letter of the name of the program. Then click on the application for that program. Dates next to each listing reflect the last update. Some applications may need to be opened with a different viewer depending on which browser you are using. Firefox users may get a message saying "This PDF document might not be displayed correctly." Try clicking on the "Open With Different Viewer" option. If you are still unable to interactively complete the application, use a different browser.
Send the completed application to the address on the application and not to NeedyMeds.
If you cannot find an application or are having trouble printing one, contact the program or company.
PANO (Novartis Patient Assistance Now Oncology/ Gleevec) Request Form 06/01/18
Pathway Reimbursement Support Patient Assistance Program Application: Contact program
Patient Access Network Foundation (PAN) Application: Contact program
PatientOne Enrollment Form for Reimbursement and Co-pay 06/18/18
PatientOne Oncology Assistance Application 04/24/18
Pertzye Assistance Program Enrollment Form 02/26/18
Pfizer Bridge Program: Contact program
Pfizer Group A Application for Primary Care Medicines 07/09/18
Pfizer Group A Application for Primary Care Medicines (Spanish) 07/09/18
Pfizer Group B Application for Oncology and Specialty Medicines 07/09/18
Pfizer Group B Application for Oncology and Specialty Medicines (Spanish) 07/09/18
Pfizer Group C Application for Vaccines 07/09/18
Pfizer Group C Application for Vaccines (Spanish) 07/09/18
Pfizer Group D Application for Lyrica 07/09/18
Pfizer Group D Application for Lyrica (Spanish) 07/09/18
Pfizer Oncology Together Enrollment Form 07/09/18
Pfizer Patient Assistance Program Medication List 07/06/18
Pfizer Savings Program Medication List 07/06/18
Photofrin Patient Assistance Program Enrollment Form 02/26/18
Prialt Access and Support Enrollment and Patient Authorization Form 04/09/18
Prolastin Direct Prescription and Enrollment Form/SMN 06/20/18
ProThelial Prescription Referral & Refill Form 02/26/18
PROVENGE Patient Assistance Application 06/18/18
PROVENGE Patient Assistance Application (Spanish) 06/14/18
Puma Patient Lynx Enrollment Form 06/12/18
Purdue Pharma Patient Assistance Program: Contact program