Pfizer Patient Assistance Program

Requirements for uninsured applicants

• Applicants must be at or below 400% federal poverty level
  • View federal poverty guidelines
• All medications from this company are shipped to the providers office with the exception of Lyrica (Lyrica is shipped to the applicant’s home)
• Refills must be called in by the providers office, the company does not allow patients to call in their own refills
• Viagra prescriptions are sent as 30-day supplies and can be re-ordered only every 45 days
• There is a separate application from Pfizer that must be filled out for Lyrica – Group D application
• Application are valid for 1 year from date of submission
  • If application is for a controlled medication, a new prescription must be submitted at or before the 6-month mark so the next refill will be able to be processed

Requirement for Medicare Part D applicants

• Medicare Part D enrollees are approved on a case by case basis
• If application is not approved initially you are able to submit an appeal letter with patient’s monthly household expenses