| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 1 of 3. Scroll down to see them all. |
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Pfizer Dermatology Patient AccessThis program provides brand name medications at no or low cost |
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Provided by: Pfizer, Inc. |
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2730 S. Edmunds Lane, TEL: 844-496-8707ALT PHONE: 833-956-3376 FAX: 877-548-1734 |
Languages Spoken:
English, Spanish, Others By Translation Service |
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Program Applications and Forms |
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Pfizer Dermatology Patient Access Prescription and Patient Enrollment Form |
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Pfizer Dermatology Patient Access Patient Assistance Program Application |
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Medications |
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Eligibility Requirements |
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| Insurance Status | Contact program for details. | ||
| Those with Part D Eligible? | Yes, but contact program for details | ||
| Income | Varies | ||
| Diagnosis/Medical Criteria | FDA-approved diagnosis | ||
| US Residency Required? | Must reside in the US | ||
Application |
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| Obtaining | Call or download | ||
| Receiving | Downloaded from website | ||
| Returning | Fax, mail or submit online | ||
| Doctor's Action | Complete section, sign, attach required documents | ||
| Applicant's Action | Call for information or inform doctor that he/she is in need | ||
| Decision Communicated | Patient and Doctor are notified | ||
| Decision Timeframe | Varies | ||
Medication |
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| Amount/Supply | Not specified | ||
| Sent To | Varies | ||
| Delivery Time | Varies | ||
| Refill Process | Not specified | ||
| Limit | Contact the program for details | ||
| Re-application | New application yearly | ||
Additional Information |
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| Co-payment assistance, patient support, and patient assistance programs are available for eligible patients. Please visit: (www.Cibinqo.com) (www.Eucrisa.com) for more information. |
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| Updated July 25, 2023 | |||
| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 2 of 3. Scroll down to see them all. |
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Pfizer RxPathwaysThis program provides patient support assistance |
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Provided by: Pfizer, Inc. |
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TEL: 844-989-7284 |
Languages Spoken:
English, Spanish |
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Program Applications and Forms |
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Pfizers RxPathways: Contact program |
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Medications |
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Eligibility Requirements |
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| Insurance Status | Contact program for details. | ||
| Those with Part D Eligible? | Yes, but contact program for details | ||
| Income | Varies | ||
| Diagnosis/Medical Criteria | FDA-approved diagnosis | ||
| US Residency Required? | Must be residing in the US or US territory | ||
Application |
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| Obtaining | Call for prescreening or apply online | ||
| Receiving | Varies | ||
| Returning | Varies | ||
| Doctor's Action | Varies | ||
| Applicant's Action | Call or enroll online | ||
| Decision Communicated | Not specified | ||
| Decision Timeframe | Varies | ||
Medication |
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| Amount/Supply | Contact the program for more details. | ||
| Sent To | Varies | ||
| Delivery Time | Varies | ||
| Refill Process | Varies per medication | ||
| Limit | Contact the program for details | ||
| Re-application | Contact program for details. | ||
Additional Information |
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| Co-payment assistance, and patient assistance programs are available for eligible patients. Call for most recent medications as the list is subject to change. |
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| Updated August 28, 2023 | |||
| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 3 of 3. | |||
Patient Access Network Foundation (PAN)This is a copay assistance program |
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Provided by: Patient Access Network Foundation |
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TEL: 866-316-7263FAX: 866-316-7261 |
Languages Spoken:
English, Spanish, Others By Translation Service |
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Program Applications and Forms |
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Patient Access Network Foundation (PAN) Application: Contact program |
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Medications |
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Eligibility Requirements |
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| Insurance Status | *See Additional Information section below | ||
| Those with Part D Eligible? | Determined case by case | ||
| Income | Between 400-500% of FPL | ||
| Diagnosis/Medical Criteria | FDA Approved Diagnosis - See Program Website for Details | ||
| US Residency Required? | Must reside and receive treatment in US | ||
Application |
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| Obtaining | Call or complete online | ||
| Receiving | Complete online or by phone | ||
| Returning | Not applicable | ||
| Doctor's Action | Varies | ||
| Applicant's Action | Call for information or inform doctor that he/she is in need | ||
| Decision Communicated | Patient and Doctor are notified | ||
| Decision Timeframe | Within 48 hours | ||
Medication |
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| Amount/Supply | Not applicable | ||
| Sent To | Patient is sent savings card to be used at pharmacy | ||
| Delivery Time | Once approved; shipped same day | ||
| Refill Process | Patient presents voucher/card to pharmacy for each refill | ||
| Limit | None | ||
| Re-application | New application every 12 months | ||
Additional Information |
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| *Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance. Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly. Note: All new enrollment is now done electronically or over the phone. Contact program for details. |
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| Updated September 06, 2023 | |||
