Access Patient Co-Pay Assistance |
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Co-pay savings are available for eligible, commercially insured patients who are prescribed certain Pfizer Oncology oral medications or certain Pfizer Oncology injectable medications. Limits, terms, and conditions apply.* Select your patient’s prescribed medication to get started.SELECT A PRODUCTSelect a product
AROMASIN® (exemestane)BOSULIF® (bosutinib)BRAFTOVI® (encorafenib)ELREXFIO™ (elranatamab-bcmm)IBRANCE® (palbociclib)INLYTA® (axitinib)LORBRENA® (lorlatinib)MEKTOVI® (binimetinib)NIVESTYM® (filgrastim-aafi)NYVEPRIA™ (pegfilgrastim-apgf)RUXIENCE® (rituximab-pvvr)SUTENT® (sunitinib malate)TALZENNA® (talazoparib)TRAZIMERA® (trastuzumab-qyyp)VIZIMPRO® (dacomitinib)XALKORI® (crizotinib)ZIRABEV® (bevacizumab-bvzr)
Please see full Prescribing Information for SUTENT (sunitinib malate), including BOXED WARNING and Medication Guide, or visit SUTENThcp.com. Please see full Prescribing Information for TRAZIMERA (trastuzumab-qyyp), including BOXED WARNING, or visit TRAZIMERAhcp.com. Please see full Prescribing Information for ELREXFIO, including BOXED WARNING and Medication Guide, or visit ELREXFIOhcp.com. Please see full Prescribing Information for RUXIENCE, including BOXED WARNING and Medication Guide, or visit RUXIENCEhcp.com. *For oral products, click here and for injectable products, click here. |
Please see RETACRIT (epoetin alfa-epbx) Medication Guide and full Prescribing Information including BOXED WARNING, or visit RETACRIThcp.com.
Please see RUXIENCE (rituximab-pvvr) Medication Guide and full Prescribing Information including BOXED WARNING, or visit RUXIENCEhcp.com.
Please see SUTENT (sunitinib malate) Medication Guide and full Prescribing Information, including BOXED WARNING regarding serious liver problems, or visit SUTENThcp.com.
Please see TRAZIMERA (trastuzumab-qyyp) full Prescribing Information including BOXED WARNING, or visit TRAZIMERAhcp.com.
The Pfizer Injectables Co-Pay Portal will allow healthcare providers, specialty pharmacies, and patients to register and enroll eligible patients in the Pfizer co-pay assistance programs for certain products. Once signed up for the new co-pay portal, users may enroll, submit claims, and see claim and payment status.
Visit the Portal
*Required
The patient is 18 years of age or older.
The patient currently lives in the United States or Puerto Rico.
For AROMASIN® (exemestane) patients, the Savings Offer is not valid for Massachusetts residents whose prescriptions are covered, in whole or in part, by third-party insurance.
The patient does not have insurance from any federal healthcare program (including Medicare, Medicaid, TRICARE, or any other state or federal medical pharmaceutical benefit program or pharmaceutical assistance program).
The patient is not over 65 years of age and retired, and if applicable, neither is their partner.
The patient does not receive Social Security Disability or any other Social Security Administration benefit.
The patient does not receive health insurance through the military.
The patient has reviewed and agreed to the Terms and Conditions and is eligible to participate in this program.
You are not licensed to practice medicine in the state of Vermont.
This form may take a few moments to submit. Please wait until you receive confirmation.
If you have questions relating to patient eligibility for the Pfizer Oncology Together Co-Pay Savings Program, you can contact Pfizer Oncology Together at 1-877-744-5675 and provide your patient's commercial insurance information to verify eligibility.
Privacy Statement for Co-Pay Savings Program: Pfizer understands that your personal and health information is private and will only use your information in accordance with our Privacy Policy. The information you provide will only be used by Pfizer and parties acting on its behalf to send you the materials you requested as well as other helpful product and/or related product information, disease state information, offers, and services.
If your patient’s medication is not listed above, they may be eligible for additional financial assistance options. Call us at 1-877-744-5675 to learn more.
The Pfizer Oncology Together Co-Pay Savings Program for Injectables provides eligible, commercially insured patients prescribed NIVESTYM with support for out-of-pocket drug costs, including co-pays and coinsurance.
Click here for a list of the full limits, terms, and conditions that apply.
HELP YOUR PATIENTS ENROLL
To get started, fax a completed enrollment form to 1-877-736-6506, or fill out an enrollment form online through our provider portal. Be sure to fill out the section requesting enrollment in the Injectables Co-Pay Program and indicate if the patient will assign benefits to the healthcare provider.
NIVESTYM CO-PAY SAVINGS PROGRAM BROCHURE
For information on enrollment, claims submission, and reimbursement, download the NIVESTYM co-pay savings program brochure.
Co-Pay claim form
To submit claims, complete the claim form below and send via fax or mail:
Fax: 1-833-307-2193
Mail: P.O. Box 10751, Fairfield, NJ 07004
VIEW FORMS
To find additional co-pay program documents and information on the claims submission process, go to the Forms & Resources page.
Pfizer Oncology Together or a local Pfizer Oncology Account Specialist can provide more information on this co-pay savings program. Give us a call at 1-877-744-5675 (Monday–Friday 8 AM–8 PM ET).
† For patients to be eligible for the Injectables Co-Pay Program for NIVESTYM, they must have commercial insurance that covers NIVESTYM® (filgrastim-aafi) and they cannot be enrolled in a state or federally funded insurance program. Whether a co-pay expense is eligible for the Injectables Co-Pay Program for NIVESTYM benefit will be determined at the time the benefit is paid. Co-pay expenses must be in connection with a separately paid claim for NIVESTYM administered in the outpatient setting.
‡ The Injectables Co-Pay Program for NIVESTYM will pay the co-pays for NIVESTYM up to the annual assistance limit of $10,000 per calendar year per patient.
§ The Injectables Co-Pay Program for NIVESTYM provides assistance for eligible, commercially insured patients for co-pays or coinsurance incurred for NIVESTYM, up to $10,000 per calendar year. It does not cover or provide support for supplies, services, procedures, or any other physician-related services associated with NIVESTYM treatment.
The Pfizer Oncology Together Co-Pay Savings Program for Injectables provides eligible, commercially insured patients prescribed NYVEPRIA with support for out-of-pocket drug costs, including co-pays and coinsurance.
Click here for a list of the full limits, terms, and conditions that apply.
HELP YOUR PATIENTS ENROLL
To get started, fax a completed enrollment form to 1-877-736-6506, or fill out an enrollment form online through our provider portal. Be sure to fill out the section requesting enrollment in the Injectables Co-Pay Program and indicate if the patient will assign benefits to the healthcare provider.
NYVEPRIA CO-PAY SAVINGS PROGRAM BROCHURE
For information on enrollment, claims submission, and reimbursement, download the NYVEPRIA co-pay savings program brochure.
Co-Pay claim form
To submit claims, complete the claim form below and send via fax or mail:
Fax: 1-833-307-2193
Mail: P.O. Box 10751, Fairfield, NJ 07004
VIEW FORMS
To find additional co-pay program documents and information on the claims submission process, go to the Forms & Resources page.
Pfizer Oncology Together or a local Pfizer Oncology Account Specialist can provide more information on this co-pay savings program. Give us a call at 1-877-744-5675 (Monday–Friday 8 AM–8 PM ET).
†For patients to be eligible for the Injectables Co-Pay Program for NYVEPRIA, they must have commercial insurance that covers NYVEPRIATM (pegfilgrastim-apgf) and they cannot be enrolled in a state or federally funded insurance program. Whether a co-pay expense is eligible for the Injectables Co-Pay Program for NYVEPRIA benefit will be determined at the time the benefit is paid. Co-pay expenses must be in connection with a separately paid claim for NYVEPRIA administered in the outpatient setting.
‡The Injectables Co-Pay Program for NYVEPRIA will pay the co-pays for NYVEPRIA up to the annual assistance limit of $10,000 per calendar year per patient.
§ The Injectables Co-Pay Program for NYVEPRIA provides assistance for eligible, commercially insured patients for co-pays or coinsurance incurred for NYVEPRIA, up to $10,000 per calendar year. It does not cover or provide support for supplies, services, procedures, or any other physician-related services associated with NYVEPRIA treatment.
The Pfizer Oncology Together Co-Pay Savings Program for Injectables provides eligible, commercially insured patients prescribed TRAZIMERA with support for out-of-pocket drug costs, including co-pays and coinsurance.
Click here for a list of the full limits, terms, and conditions that apply.
HELP YOUR PATIENTS ENROLL
To get started, fax a completed enrollment form to 1-877-736-6506, or fill out an enrollment form online through our provider portal. Be sure to fill out the section requesting enrollment in the Injectables Co-Pay Program and indicate if the patient will assign benefits to the healthcare provider.
TRAZIMERA CO-PAY SAVINGS PROGRAM BROCHURE
For information on enrollment, claims submission, and reimbursement, download the TRAZIMERA co-pay savings program brochure.
Co-Pay claim form
To submit claims, complete the claim form below and send via fax or mail:
Fax: 1-833-307-2193
Mail: P.O. Box 10751, Fairfield, NJ 07004
VIEW FORMS
To find additional co-pay program documents and information on the claims submission process, go to the Forms & Resources page.
Pfizer Oncology Together or a local Pfizer Oncology Account Specialist can provide more information on this co-pay savings program. Give us a call at 1-877-744-5675 (Monday–Friday 8 AM–8 PM ET).
†For patients to be eligible for the Injectables Co-Pay Program for TRAZIMERA, they must have commercial insurance that covers TRAZIMERATM (trastuzumab-qyyp) and they cannot be enrolled in a state or federally funded insurance program. Whether a co-pay expense is eligible for the Injectables Co-Pay Program for TRAZIMERA benefit will be determined at the time the benefit is paid. Co-pay expenses must be in connection with a separately paid claim for TRAZIMERA administered in the outpatient setting.
‡ The Injectables Co-Pay Program for TRAZIMERA will pay the co-pays for TRAZIMERA up to the annual assistance limit of $25,000 per calendar year per patient.
§ The Injectables Co-Pay Program for TRAZIMERA provides assistance for eligible, commercially insured patients for co-pays or coinsurance incurred for TRAZIMERA, up to $25,000 per calendar year. It does not cover or provide support for supplies, services, procedures, or any other physician-related services associated with TRAZIMERA treatment.
The Pfizer Oncology Together Co-Pay Savings Program for Injectables provides eligible, commercially insured patients prescribed RUXIENCE with support for out-of-pocket drug costs, including co-pays and coinsurance.
Patients prescribed RUXIENCE for certain conditions are not eligible for this co-pay savings program.
Click here for a list of the full limits, terms, and conditions that apply.
HELP YOUR PATIENTS ENROLL
To get started, fax a completed enrollment form to 1-877-736-6506, or fill out an enrollment form online through our provider portal. Be sure to fill out the section requesting enrollment in the Injectables Co-Pay Program and indicate if the patient will assign benefits to the healthcare provider.
RUXIENCE CO-PAY SAVINGS PROGRAM BROCHURE
For information on enrollment, claims submission, and reimbursement, download the RUXIENCE co-pay savings program brochure.
Co-Pay claim form
To submit claims, complete the claim form below and send via fax or mail:
Fax: 1-833-307-2193
Mail: P.O. Box 10751, Fairfield, NJ 07004
VIEW FORMS
To find additional co-pay program documents and information on the claims submission process, go to the Forms & Resources page.
Pfizer Oncology Together or a local Pfizer Oncology Account Specialist can provide more information on this co-pay savings program. Give us a call at 1-877-744-5675 (Monday–Friday 8 AM–8 PM ET).
†For patients to be eligible for the Injectables Co-Pay Program for RUXIENCE, they must have commercial insurance that covers RUXIENCE™ (rituximab-pvvr) and they cannot be enrolled in a state or federally funded insurance program. Whether a co-pay expense is eligible for the Injectables Co-Pay Program for RUXIENCE benefit will be determined at the time the benefit is paid. Co-pay expenses must be in connection with a separately paid claim for RUXIENCE administered in the outpatient setting.
‡ The Injectables Co-Pay Program for RUXIENCE will pay the co-pays for RUXIENCE up to the annual assistance limit of $25,000 per calendar year per patient.
§ The Injectables Co-Pay Program for RUXIENCE provides assistance for eligible, commercially insured patients for co-pays or coinsurance incurred for RUXIENCE, up to $25,000 per calendar year. It does not cover or provide support for supplies, services, procedures, or any other physician-related services associated with RUXIENCE treatment.
The Pfizer Oncology Together Co-Pay Savings Program for Injectables provides eligible, commercially insured patients prescribed ZIRABEV with support for out-of-pocket drug costs, including co-pays and coinsurance.
Patients prescribed ZIRABEV for certain conditions are not eligible for this co-pay savings program.
Click here for a list of the full limits, terms, and conditions that apply.
HELP YOUR PATIENTS ENROLL
To get started, fax a completed enrollment form to 1-877-736-6506, or fill out an enrollment form online through our provider portal. Be sure to fill out the section requesting enrollment in the Injectables Co-Pay Program and indicate if the patient will assign benefits to the healthcare provider.
ZIRABEV CO-PAY SAVINGS PROGRAM BROCHURE
For information on enrollment, claims submission, and reimbursement, download the ZIRABEV
co-pay savings program brochure.
Co-Pay claim form
To submit claims, complete the claim form below and send via fax or mail:
Fax: 1-833-307-2193
Mail: P.O. Box 10751, Fairfield, NJ 07004
VIEW FORMS
To find additional co-pay program documents and information on the claims submission process, go to the Forms & Resources page.
Pfizer Oncology Together or a local Pfizer Oncology Account Specialist can provide more information on this co-pay savings program. Give us a call at 1-877-744-5675 (Monday–Friday 8 AM–8 PM ET).
† For patients to be eligible for the Injectables Co-Pay Program for ZIRABEV, they must have commercial insurance that covers ZIRABEVTM (bevacizumab-bvzr) and they cannot be enrolled in a state or federally funded insurance program. Whether a co-pay expense is eligible for the Injectables Co-Pay Program for ZIRABEV benefit will be determined at the time the benefit is paid. Co-pay expenses must be in connection with a separately paid claim for ZIRABEV administered in the outpatient setting.
‡ The Injectables Co-Pay Program for ZIRABEV will pay the co-pays for ZIRABEV up to the annual assistance limit of $25,000 per calendar year per patient.
§ The Injectables Co-Pay Program for ZIRABEV provides assistance for eligible, commercially insured patients for co-pays or coinsurance incurred for ZIRABEV, up to $25,000 per calendar year. It does not cover or provide support for supplies, services, procedures, or any other physician-related services associated with ZIRABEV treatment.
Your patient may not be eligible for co-pay assistance if their medication is not listed above. For additional financial assistance questions, call us at 1-877-744-5675.
Need assistance?Call 1-877-744-5675 (Monday–Friday 8 AM–8 PM ET)
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