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Navigating access and reimbursement.
Together.

If patients need access or reimbursement support for their prescribed Pfizer Oncology medications, we’re here to help.

Insurance Assistance

The process and paperwork related to insurance coverage can be daunting. If your patients need support, Pfizer Oncology Together is here to help.

We can conduct a benefits verification to determine a patient's health insurance coverage and out-of-pocket costs. After verifying coverage, we'll provide a summary of benefits for oral and injectable medications:

  • A summary of benefits will be faxed to you
  • A call is made to the patient to review the summary of benefits verbally, and a copy is mailed to them, if requested

We’ll coordinate with a patient’s insurer to determine the PA requirements, where and how to submit requests, and typical turnaround times. After your office submits a PA request, we’ll follow up with the insurer on behalf of the patient to track the progress and status, upon your request.

Below are sample templates and checklists that may be helpful in cases where additional information is required by the insurer.

Sample Letter of Medical Necessity

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Letter of Medical Necessity Checklist

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Prior Authorization Checklist

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We can review the reasons for a denied claim and help with the appeals process by providing information on payer requirements.

Sample Letter of Appeals

Letter of Appeal Checklist

PfizerOncologyPortal.com provides 24/7 access to helpful resources and information where registered users can:

  • Complete and submit an online enrollment form
  • View secure messaging, including patient status alerts via email
  • Generate patient status reports and co-pay usage for certain injectable medications
  • Access forms, tools, and resources for specific Pfizer Oncology medications, including billing and coding guides for injectable medications
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Get Insurance forms and resources

Find sample letters, checklists, and other insurance support resources on the Forms & Resources page.

Explore Resources

Product Access

To help your patients access the medication you've prescribed, we can identify specialty pharmacy options. If you prefer, you and your staff can also continue to work directly with specialty pharmacies.

BESPONSA® (inotuzumab ozogamicin) and MYLOTARG™ (gemtuzumab ozogamicin) are available through a network of specialty distributors and specialty pharmacies.

Injectable biosimilars are available through most major wholesalers.

Specialty Pharmacies

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Specialty Distributors

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Please see full Prescribing Information for BESPONSA (inotuzumab ozogamicin), including BOXED WARNING, or visit BESPONSAhcp.com.

Please see full Prescribing Information for MYLOTARG (gemtuzumab ozogamicin), including BOXED WARNING, or visit MYLOTARGhcp.com.

Billing & Coding Information

For your patient's claims submissions, we provide easy access to sample forms and template letters, along with billing and coding information for physician’s office and hospital outpatient settings of care.*

Pfizer Oncology Biosimilars Q Codes:

In the physician's office and hospital outpatient department sites of care, Medicare Administrative Contractors (MACs), private commercial payers, and Medicaid may recognize the following codes for reporting a biosimilar on claim forms.

Product HCPCS Code Descriptor
NIVESTYM® (filgrastim-aafi) Q5110
Injection, filgrastim-aafi, biosimilar, (NIVESTYM), 1 microgram
NYVEPRIA™ (pegfilgrastim-apgf) Q5122
Injection, pegfilgrastim-apgf, biosimilar, (NYVEPRIA), 0.5 mg
RETACRIT® (epoetin alfa-epbx)
Q5105
Q5106
Injection, epoetin alfa-epbx, biosimilar, (RETACRIT) (for ESRD on dialysis), 100 units
Injection, epoetin alfa-epbx, biosimilar, (RETACRIT) (for non-ESRD use), 1,000 units
RUXIENCE® (rituximab-pvvr) Q5119
Injection, rituximab-pvvr, biosimilar, (RUXIENCE), 10 mg
TRAZIMERA® (trastuzumab-qyyp) Q5116
Injection, trastuzumab-qyyp, biosimilar, (TRAZIMERA), 10 mg
ZIRABEV® (bevacizumab-bvzr) Q5118
Injection, bevacizumab-bvzr, biosimilar, (ZIRABEV), 10 mg
For additional billing and coding information, download the guides below.
BIOSIMILARS:

NIVESTYM BILLING & CODING GUIDE

NYVEPRIA BILLING & CODING GUIDE

RETACRIT Billing & Coding Guide

RUXIENCE Billing & Coding Guide

TRAZIMERA Billing & Coding Guide

ZIRABEV Billing & Coding Guide

BESPONSA® (inotuzumab ozogamicin) & MYLOTARG™ (gemtuzumab ozogamicin)

BESPONSA Sample UB-04/CMS-1450 Form For Hospital Outpatient Use

BESPONSA Sample CMS-1500 Form For Physician Office Use

MYLOTARG Sample UB-04/CMS-1450 FORM FOR HOSPITAL OUTPATIENT USE

MYLOTARG Sample CMS-1500 Form For Physician Office Use

Please see full Prescribing Information for BESPONSA, including BOXED WARNING, or visit BESPONSAhcp.com.

Please see full Prescribing Information for MYLOTARG, including BOXED WARNING, or visit MYLOTARGhcp.com.

Please see full Prescribing Information for RETACRIT, including BOXED WARNING and Medication Guide, or visit RETACRIThcp.com.

Please see full Prescribing Information for RUXIENCE, including BOXED WARNING and Medication Guide, or visit RUXIENCEhcp.com.

Please see full Prescribing Information for TRAZIMERA, including BOXED WARNING, or visit TRAZIMERAhcp.com.

The sample forms are intended as a reference for billing and coding of BESPONSA, MYLOTARG, ZIRABEV, RUXIENCE, TRAZIMERA, RETACRIT, and NIVESTYM. These forms are not intended to be directive or to replace clinical decision-making, and the use of the recommended codes does not guarantee reimbursement. Healthcare providers may deem other codes or policies more appropriate and should select the coding options that most accurately reflect their internal guidelines, payer requirements, practice requirements, practice patients, and the services rendered.

Find a Local Representative

FOR PRODUCT SUPPORT

If you have questions about a specific Pfizer Oncology product, a Pfizer Oncology Account Specialist can help provide detailed information—in your office or over the phone.

Find a Pfizer Oncology Account Specialist in your area:

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Select a product
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Please see full Prescribing Information for BESPONSA, including BOXED WARNING, or visit BESPONSAhcp.com.
Please see full Prescribing Information for DAURISMO (glasdegib), including BOXED WARNING and Medication Guide, or visit DAURISMOhcp.com.
Please see full Prescribing Information for MYLOTARG, including BOXED WARNING, or visit MYLOTARGhcp.com.
Please see full Prescribing Information for RETACRIT, including BOXED WARNING and Medication Guide, or visit RETACRIThcp.com.
Please see full Prescribing Information for RUXIENCE, including BOXED WARNING and Medication Guide, or visit RUXIENCEhcp.com.
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, including BOXED WARNING, or visit TRAZIMERAhcp.com.