The process and paperwork related to insurance coverage can be daunting. If your patients need support, Pfizer Oncology Together is here to help.
PfizerOncologyPortal.com provides 24/7 access to helpful resources and information where registered users can:
*The Pfizer Patient Assistance Program is a joint program of Pfizer Inc. and the Pfizer Patient Assistance Foundation™. The Pfizer Patient Assistance Foundation is a separate legal entity from Pfizer Inc. with distinct legal restrictions.
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:
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 NecessityDownload
Letter of Medical Necessity ChecklistDownload
Prior Authorization ChecklistDownload
Find sample letters, checklists, and other insurance support resources on the Forms & Resources page.Explore Resources
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.
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.†
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.
Injection, filgrastim-aafi, biosimilar, (NIVESTYM), 1 microgram
Injection, pegfilgrastim-apgf, biosimilar, (NYVEPRIA), 0.5 mg
|RETACRIT® (epoetin alfa-epbx)||
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
Injection, rituximab-pvvr, biosimilar, (RUXIENCE), 10 mg
Injection, trastuzumab-qyyp, biosimilar, (TRAZIMERA), 10 mg
Injection, bevacizumab-bvzr, biosimilar, (ZIRABEV), 10 mg
ZIRABEV Billing & Coding Guide
MYLOTARG Sample CMS-1500 Form For Physician Office Use
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.
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:
If you have questions or need assistance for a specific patient case, Pfizer Oncology Field Reimbursement Managers (FRMs) are trained to help address access issues—in person or over the phone. They can help educate your staff on our access and reimbursement resources, and assist with challenging or urgent Pfizer Oncology patient cases you have sent to Pfizer Oncology Together.
Please contact your Account Specialist to find out more about the support available.