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Choose the Support You’re Interested In

Select one or both options:

1:1 Personalized Support

We can connect you to free resources that may provide practical and emotional support, educational materials to help you navigate treatment, and transportation and lodging resources.*

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Patient Financial Assistance & Reimbursement Support

Eligible, commercially insured patients may pay as little as $0 per month for their Pfizer Oncology treatment. Limits, terms, and conditions apply.* Patients may receive up to $10,000 per product in savings annually.

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Please note, you must be at least 18 years of age to complete this form. If you are under 18 or need assistance, please call 1-877-744-5675 (Monday–Friday 8 AM –8 PM ET) for support.

*Some services are provided through third-party organizations that operate independently and are not controlled by Pfizer. Availability of services and eligibility requirements are determined solely by these organizations. Opt-in required.

Co-Pay Enrollment Requires an Extra Step

Co-pay enrollment for injectable medicines isn't directly available on this site. Once you complete your 1:1 support sign-up, we'll direct you to the official Pfizer co-pay portal to finish enrolling for savings.

Co-pay enrollment for injectable medicines isn't available directly on this site. Please visit the official Pfizer co-pay portal to complete your enrollment and access potential savings.

What best describes you?

Select one:

I have been prescribed a Pfizer Oncology medicine (or treatment)

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I am caring for a patient who was prescribed a Pfizer Oncology medicine (or treatment)

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We ask this so we can personalize our support and communications appropriately.

First, please tell us about yourself.

Required

First Name

Middle

Last Name

Date of Birth

Phone Number

Type

Select

Select
Mobile
Home
Work

Email Address

Add your caregiver address so we can follow up if needed.

Required

Address 1

Address 2

City

State

Select State

Select State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington, DC
West Virginia
Wisconsin
Wyoming

ZIP Code

Next, tell us about the person you’re providing care for.

Required

First Name

Middle

Last Name

Email Address

Date of Birth

Phone Number

Type

Select

Select
Mobile
Home
Work

Sex

Select

Select
Male
Female

Which doctor prescribed this medicine?

First Name

Last Name

What’s the patient’s address?

Required

Is the patient’s address the same as yours?

Yes

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No, I’ll enter a different address

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Address 1

Address 2

City

State

Select State

Select State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington, DC
West Virginia
Wisconsin
Wyoming

ZIP Code

Let’s verify that you meet the co-pay program requirements.

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Please verify the following information to receive a co-pay savings card:

NOTE: The questions and fields below should be filled out by the patient or their caregiver. If you are a healthcare professional, visit the Healthcare Professional website to find out if your patient is eligible to access the co-pay card.

Eligible patients must:

Be 18 years of age or older
Currently live in the United States or Puerto Rico
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)
Not be over 65 years of age and not retired and, if the patient has a partner, the same would apply to their partner
Not receive Social Security Disability or any other Social Security Administration benefit
Not receive health insurance through the military
Review and agree to the Terms and Conditions and attest that the patient is eligible to participate in this program

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By checking this box, I confirm that the defined requirements above have been met.

If you have questions relating to patient eligibly for the Pfizer Oncology Together Co-Pay Savings Program, you can contact Pfizer Oncology Together at 1-877-744-5675 (Monday–Friday 8 AM–8 PM ET) and provide the patient's commercial insurance information to verify eligibility.

You’re almost done—agree to receive communications about your support.

Required

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User Consent

By checking this box, I request Pfizer Oncology Together support and agree to receive telephonic communications from the support specialist assigned to my case as described above. I understand that my consent is not required or a condition of purchasing any Pfizer goods or services.

I can opt out of support from and communications with the support specialist at any time by informing my assigned support specialist that I no longer wish to communicate with them.

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.

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By checking this box, I also agree to receive communications from Pfizer Oncology Together, a support program that offers financial assistance and personalized resources for patients prescribed Pfizer Oncology medicines.

Looking for assistance?

Call 1-877-744-5675

Mon–Fri, 8 AM–8 PM ET

Looking for assistance?

Call 1-877-744-5675

Mon–Fri, 8 AM–8 PM ET

Please see Important Facts about ADCETRIS, including BOXED WARNING, or visit ADCETRIS.com.

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

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

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

Please see MYLOTARG full Prescribing Information, including BOXED WARNING.

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

Please see RUXIENCE Medication Guide and full Prescribing Information, including BOXED WARNING.

Please see SUTENT Medication Guide and full Prescribing Information, including BOXED WARNING regarding serious liver problems, or visit SUTENT.com.

Please see TIVDAK Medication Guide and full Prescribing Information, including IMPORTANT WARNING, or visit TIVDAK.com.

Please see TRAZIMERA full Prescribing Information, including BOXED WARNING.

Pfizer Oncology Together services are available to residents of the United States only. The product information provided in this site is intended only for U.S. residents. The products discussed in this site may have different product labeling in different countries.

The health information in this site is provided for educational purposes only and is not intended to replace discussions with a healthcare professional. All decisions regarding patient care must be made with a healthcare professional, considering the unique characteristics of the patient.

Sign up for support

Choose the Support You’re Interested In

1:1 Personalized Support

Patient Financial Assistance & Reimbursement Support

Co-Pay Enrollment Requires an Extra Step

What best describes you?

I have been prescribed a Pfizer Oncology medicine (or treatment)

I am caring for a patient who was prescribed a Pfizer Oncology medicine (or treatment)

First, please tell us about yourself.

Add your caregiver address so we can follow up if needed.

Next, tell us about the person you’re providing care for.

Which doctor prescribed this medicine?

What’s the patient’s address?

Yes

No, I’ll enter a different address

Let’s verify that you meet the co-pay program requirements.

Please verify the following information to receive a co-pay savings card:

Eligible patients must:

You’re almost done—agree to receive communications about your support.