FREE MEDICINE
We'll see if you’re eligible to receive up to a 90-day supply of Pfizer medicines for free while applying for Medicaid. If you do not qualify for Medicaid, you may be able to receive your medication for free for up to 1 year through the Pfizer Patient Assistance Program.^† You must meet the eligibility requirements and reapply as needed.

Ask your healthcare team to complete an enrollment form with you to start the process of applying for the Pfizer Patient Assistance Program.

You can opt in to Electronic Income Verification or provide proof of income, such as the prior year’s tax return (preferred), your most current W2 form, or the 3 most recent paycheck stubs for all household members.^§

To qualify for free medication^{​​​​​​​||} from the Pfizer Patient Assistance Program, you must meet certain criteria:

• Have a valid prescription for the Pfizer medication for an FDA-approved indication and the physician has attested to this on the enrollment form

• Have an annual household income at or below 500% of the Federal Poverty Level

• Be 18 years of age or older

• Reside in the U.S. or a U.S. territory

• Be treated by a healthcare provider licensed in the U.S. or a U.S. territory

• Meet one of the following:

  • Have no insurance coverage

  • Have government insurance, understand co-pay requirements as a result of the completion of a Benefit Investigation/Pharmacy Claim, and are unable to afford your insurer-required co-pay

  • Have been denied coverage by your government insurer for a Pfizer medication (after at least one unsuccessful appeal to your insurer)

If you are accepted into the Pfizer Patient Assistance Program, Pfizer will send your oral medicine directly to you after confirming your shipping information.

When you’re ready for a refill, you can call Pfizer Oncology Together to request one (typically, when you only have a 10-day supply or less). If you would prefer to be contacted by text message instead, please check section 5 of the enrollment form and provide your mobile number.