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How can we help?

 

Access Patient Co-Pay Assistance

Select your patient's medication to find out if they’re eligible and to access co-pay assistance.

HCP copay form

Please answer the following eligibility questions:

Pfizer Oncology Together Co-Pay Program for IV

The Pfizer Oncology Together Co-Pay Program for IV (“IV Co-Pay Program”) provides eligible patients with support for out-of-pocket drug costs, including co-pays, co-insurance, and deductibles. Limits, terms, and conditions apply.

HELP YOUR PATIENTS ENROLL

To get started, fax a completed enrollment form to 1-877-736-6506. Be sure to check the box for Intravenous (IV) Co-Pay Program and indicate if the patient will assign benefit to the healthcare provider.

enrollment form

For eligible, commercially insured patients

Co-pays may be as little as $0. Once the annual program limit is reached, the patient is responsible for the full co-pay.#

UP TO $25,000 PER CALENDAR YEAR

Program covers up to $25,000 per calendar year.**

No income requirements

There are no income requirements for patients to qualify.

OTHER RESOURCES

For information on claim submission or reimbursement processes, download the IV Co-Pay Program Brochure.

IV CO-PAY PROGRAM BROCHURE

To submit claims by fax or mail, complete and fax the Co-Pay Claim Form to 1-908-809-6241.

CO-PAY CLAIM FORM

For detailed instructions on Electronic Funds Transfer (EFT), Electronic Remittance Advice (ERA), or Electronic Data Interchange (EDI), go to the Forms & Resources page.

VIEW FORMS

For patients to be eligible for the IV Co-Pay Program, they must have commercial insurance that covers BESPONSA™ (inotuzumab ozogamicin) or MYLOTARG™ (gemtuzumab ozogamicin) (each referred to as “Product”) and they cannot be enrolled in a state or federally funded insurance program. Whether a co-pay expense is eligible for the IV Co-Pay Program benefit will be determined at the time the benefit is paid. Co-pay expenses must be in connection with a separately paid claim for Product administered in the outpatient setting.

#The IV Co-Pay Program will pay the co-pay and any deductible obligations for the Product up to the annual assistance limit of $25,000 per calendar year per patient.

**The IV Co-Pay Program provides assistance for eligible, commercially insured patients for co-pays, co-insurance, or deductibles incurred for the Product, 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 Product treatment.

Pfizer Oncology Together Co-Pay Savings Program for Injectables for ZIRABEV

The Pfizer Oncology Together Co-Pay Savings Program for Injectables for ZIRABEV provides eligible patients with support for out-of-pocket drug costs, including co-pays and coinsurance. Limits, terms, and conditions apply.

HELP YOUR PATIENTS ENROLL

To get started, fax a completed enrollment form to 1-877-736-6506. Be sure to check the box for Injectables Co-Pay Program and indicate if the patient will assign benefits to the healthcare provider.

enrollment form

For eligible, commercially insured patients#

Eligible patients may pay as little as $0 for each ZIRABEV treatment. **

UP TO $25,000 PER CALENDAR YEAR

The program covers up to $25,000 per calendar year. ††

No income requirements

There are no income requirements for you to qualify.

OTHER RESOURCES

For information on enrollment, claims submission, and reimbursement, download the Pfizer Oncology Together Co-Pay Savings Program for Injectables for ZIRABEV brochure.

Zirabev Co-Pay Savings Program Brochure

 

To submit claims, complete the Pfizer Oncology Together Co-Pay Savings Program for Injectables for ZIRABEV
Claim Form and send via fax or mail:
Fax: 1-973-843-1916
Mail: P.O. Box 10514, Fairfield, NJ 07004

Co-pay claim form

 

For Sample forms and additional co-pay program documents, go to the Forms & Resources page.

View forms

CONTACT US FOR MORE INFORMATION

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, they must have commercial insurance that covers ZIRABEV™ (bevacizumab-bvzr) (referred to as “Product”) 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 benefit will be determined at the time the benefit is paid. Co-pay expenses must be in connection with a separately paid claim for Product administered in the outpatient setting.

**The Injectables Co-Pay Program will pay the co-pay and any deductible obligations for the Product up to the annual assistance limit of $25,000 per calendar year per patient.

††The Injectables Co-Pay Program provides assistance for eligible, commercially insured patients for co-pays, coinsurance, or deductibles incurred for the Product, 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 Product treatment.

Pfizer Oncology Together Co-Pay Savings Program for Injectables: NIVESTYM™ (filgrastim-aafi)

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. Limits, terms, and conditions apply.

HELP YOUR PATIENTS ENROLL

To get started, fax a completed enrollment form to 1-877-736-6506. Be sure to check the box for Injectables Co-Pay Program and indicate if the patient will assign benefits to the healthcare provider.

enrollment form

For eligible, commercially insured patients#

Eligible patients may pay as little as $0 for each NIVESTYM treatment.**

UP TO $10,000 PER CALENDAR YEAR

The program covers up to $10,000 per calendar year.††

No income requirements

There are no income requirements for patients to qualify.

OTHER RESOURCES

For information on enrollment, claims submission, and reimbursement, download the NIVESTYM co-pay savings program brochure below.

NIVESTYM Co-Pay Savings Program Brochure

 

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

Co-pay claim form

 

To find additional co-pay program documents and information on the claims submission process, go to the Forms & Resources page.

View forms

CONTACT US FOR MORE INFORMATION

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.

ADDITIONAL ASSISTANCE

Free medication may be available to eligible patients through the Pfizer Patient Assistance Program.†
Contact Pfizer Oncology Together for more information.

†The Pfizer Patient Assistance Program is a joint program of Pfizer Inc. and Pfizer Patient Assistance Foundation™. The Pfizer Patient Assistance Foundation is a separate legal entity from Pfizer Inc. with distinct legal restrictions.

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