Financial Support—Co-pay Card & Resources

Financial Support—Co-pay Card & Resources
INLYTA is committed to supporting your patients throughout their treatment journey. With Pfizer Oncology Together, patients get personalized support services, including help identifying financial assistance options and connections to resources that may help with some of their day-to-day challenges.*
*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.
Patient Financial Assistance

COMMERCIALLY INSURED
Resources for eligible commercial, private, employer, and state health insurance marketplace patients:
  • Co-pay assistance—eligible patients may pay as little as $0 per month, regardless of income
$0 co-pay card for eligible patients
Eligible, commercially insured patients may pay as little as $0 per month for INLYTA.
  • Simple enrollment with no income requirements, enrollment forms, or faxing
  • Co-pay savings upon activation

Limits, terms, and conditions apply. Patients may receive up to $25,000 in savings annually. The offer will be accepted only at participating pharmacies. This offer is not health insurance. No membership fees apply. For any questions, please call 1-877-744-5675, visit PfizerOncologyTogether.com/terms or write: Pfizer Oncology Together Co-Pay Savings Program, 2250 Perimeter Park Drive, Suite 300, Morrisville, NC 27560.

MEDICARE/GOVERNMENT INSURED
Help identifying resources for patients with Medicare/Medicare Part D, Medicaid, and other government insurance plans
  • Assistance for patients with searching for financial support that may be available from independent charitable foundations
    —These foundations exist independently of Pfizer and have their own eligibility criteria and application processes
    —Availability of support is determined solely by the foundations
  • Free medication for eligible patients

UNINSURED
Help identifying resources for patients without any form of healthcare coverage:
  • Help finding coverage
  • Free medication§ or savings for eligible patients
If independent charitable foundation support is not available, Pfizer Oncology Together will provide eligible patients with medication for free through the Pfizer Patient Assistance Program. 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.
§Provided through the Pfizer Patient Assistance Program, which 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.

NEED INLYTA STARTER SAMPLES? CONTACT YOUR PFIZER SALES REPRESENTATIVE

Free 30-day trial voucher for new INLYTA patients||
Pfizer is committed to helping eligible patients receive INLYTA therapy quickly.
New patients who have been prescribed INLYTA can now start a free 30-day trial with this voucher, regardless of coverage status.
||Terms and conditions apply. See below.
To utilize this voucher, you must have a valid prescription. There is no obligation to continue INLYTA. To continue a patient on therapy, a separate prescription must be written to be filled at the patient's specialty pharmacy of choice. Patients may be offered enrollment in the trial voucher exclusively through their healthcare provider.
Terms and Conditions for Voucher Program
By enrolling in the 30-day trial voucher offer for INLYTA, you acknowledge that you currently meet the eligibility criteria and will comply with the Terms and Conditions described below:
  1. Voucher is valid for 30 days of dosing of INLYTA, not to exceed 5 mg twice daily for 30 days, for new patients.
  2. The voucher will be accepted only at participating pharmacies.
  3. No claim for reimbursement for product dispensed pursuant to this voucher may be submitted to any third-party payer, whether a private or government payer.
  4. This free trial voucher is not valid for Massachusetts residents whose prescriptions are covered in whole or in part by third-party insurance, or where otherwise prohibited by law.
  5. This free trial voucher cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription.
  6. This free trial is not health insurance.
  7. Offer good only in the United States and Puerto Rico.
  8. Only patients new to INLYTA may use this voucher. By redeeming this voucher, you certify that you are not currently using INLYTA. Only 1 voucher per person may be redeemed under this program. This voucher is not transferable.
  9. Pfizer reserves the right to rescind, revoke, or amend this free trial voucher without notice.
  10. The free trial voucher expires 12/31/2019.

Access & Reimbursement Support

INSURANCE SUPPORT
We can help patients with:
  • Benefits verification
  • Prior authorizations
  • Appeals

DEDICATED LOCAL SUPPORT  
Your local Pfizer Oncology Account Specialist can provide detailed information about INLYTA® (axitinib) and help you access a Pfizer Field Reimbursement Manager (FRM) in your area. FRMs are trained resources who can help address specific access and reimbursement issues.
Learn more about Access & Reimbursement

Specialty Pharmacy Coordination 
To help your patients access the medication you’ve prescribed, we can identify specialty pharmacy options.
If you prefer, you and your staff can continue to work directly with specialty pharmacies.
INLYTA IS AVAILABLE THROUGH SPECIFIC SPECIALTY PHARMACIES 
Contact the specialty pharmacy directly to fill the prescription if one of the following applies:
  • Your office knows the patient’s specialty pharmacy
  • Your patient knows that the specialty pharmacy is covered in his/her plan and that the pharmacy is in the treatment network
  • Your office uses a specialty pharmacy that’s in the patient’s network

Personalized Patient Support

When your patients need support for their day-to-day challenges, we want to be a place they can turn to for help. That’s why Pfizer Oncology Together provides them with a dedicated Care Champion. Our Care Champions, who have social work experience, are ready to listen to patients and connect them to resources that may help with some of their challenges.*
  • Resources for emotional support and other daily challenges
  • Lodging and transportation from an independent organization for treatment-related appointments
  • Information to help patients who are leaving work or preparing to return to work
  • Patient education, including nutritional information, communication tips, and toolkits specific to their medicine
  • Financial support options—regardless of insurance coverage
Click here to connect to all of our resources
*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.
SUPPORT STARTS HERE
For live support, call 1-877-744-5675
(Monday–Friday 8 AM–8 PM ET)
Or visit PfizerOncologyTogether.com to learn more

To enroll, fax forms to 1-877-736-6506


Terms and Conditions for Co-pay Card
By enrolling in this co-pay offer, you acknowledge that you currently meet the eligibility criteria and will comply with the Terms and Conditions described below:
  • This card is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, Tricare or other federal or state healthcare programs (including any state prescription drug assistance programs) and the Government Health Insurance Plan available in Puerto Rico (formerly known as “La Reforma de Salud”).
  • This card is not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private insurance plans or other health or pharmacy benefit programs.
  • With this card you will pay a $0 co-pay per eligible monthly prescription, subject to a maximum benefit of $25,000 per calendar year. The amount of any benefit is the difference between your co-pay and $0. After the maximum of $25,000 you will be responsible for the remaining monthly out-of-pocket costs. This card may be used once per 30 days until the maximum benefit has been reached. The average benefit is $437.55 per patient per year. 
  • You must deduct the value of the benefit you receive with this card from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf.  
  • This card is not valid where prohibited by law. 
  • Card cannot be combined with any other rebate/coupon, free trial or similar offer for the specified prescription.
  • Card will be accepted only at participating pharmacies.  
  • This card is not health insurance.
  • Offer good only in the U.S. and Puerto Rico. 
  • Card is limited to 1 per person during this offering period and is not transferable.  
  • Pfizer reserves the right to rescind, revoke or amend this offer without notice. 
  • No membership fee.
  • Offer expires 12/31/2019. 
  • For reimbursement when using a nonparticipating pharmacy: Mail a copy of the patient’s pharmacy receipt indicating patient name, name of medication purchased, price paid, and date purchased, along with a copy of the patient’s Pfizer Oncology Together Co-Pay Savings Program Card, to:
    Pfizer Oncology Together Co-Pay Savings Program
    2250 Perimeter Park Drive, Suite 300
    Morrisville, NC 27560