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Connection To Care® Patient Application (English)
Connection to Care provides free Pfizer medicines to uninsured patients and patients with prescription coverage who are faced with a significant financial hardship. Connection to Care enrollment is easy with our user-friendly patient application. To request a Connection to Care application for your patients, call 1-866-706-2400, or download it here.
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Connection To Care® Patient Application (Spanish)
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Connection To Care® Authorization Form
In addition to completing an application, your patients must sign the authorization form above and provide it to you. It allows you to share certain patient information with Pfizer in connection with the program. This form should not be returned with the patient application.
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Enrolled Patient Order Form
To reorder Pfizer medicines for your enrolled patients, download an
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Pfizer MAINTAIN™application (English)
MAINTAIN™ is a program that helps eligible people in financial need continue to get their Pfizer medicines if they became unemployed on or after 1/1/09 and do not have prescription coverage. Participating patients will receive their Pfizer medicines for free for up to one year, or until they become insured again, whichever comes first. To request a MAINTAIN™ application for your patients call 1-866-706-2400, or download it here.
The application for MAINTAIN™ will be accepted through 12/31/2010.
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Pfizer MAINTAIN™ application (Spanish)
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Pfizer Pfriends Application (English)
Pfizer Pfriends offers savings on 88 Pfizer medicines at participating pharmacies in the United States, Puerto Rico, and the U.S. Virgin Islands. To request a Pfizer Pfriends application for your patients, call 1-866-706-2400, or download it here.
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Pfizer Pfriends Application (Spanish)
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Pfizer RSVP Application (English)
RSVP is a reimbursement support and patient assistance program that can help insured patients and patients in need gain access to the Pfizer medicines they need. To request an RSVP application for your patients call 1-888-327-7787, or download it here.
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Pfizer RSVP Application (Spanish)
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First Resource® for Oncology Professionals
Pfizer First Resource is a comprehensive reimbursement and patient assistance program designed to help you and your patients access Pfizer medicines. To request a First Resource application for your patients, call 1-877-744-5675, or visit First Resource online at