Pfizer Patient Assistance Program: Dermatology: Cibinqo, Litfulo

Funded

About

The Pfizer Patient Assistance Program: Dermatology offers invaluable support to eligible individuals by providing access to medications such as Cibinqo and Litfulo at little to no cost. This program is specifically designed to assist those who are uninsured or publicly insured and face difficulties affording their medication copayments. With upcoming changes in eligibility commencing January 1, 2024, this program remains a crucial resource for qualifying patients who meet the income guidelines and receive treatment from a licensed healthcare provider in the United States or its covered territories.

Insurance requirements: Uninsured

Enrollment Forms

Enrollment Form

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: Yes

•Activation Required: No

Program Details

•PLEASE Effective January 1, 2024, eligibility requirements will be changing. Please visit https://www.pfizerrxpathways.com/updates for more information

•Patients with commercial insurance are not eligible for the Pfizer Patient Assistance Program, even if the medication is not covered by the commercial insurance plan

•Eligible uninsured patients may be able to receive free medication

•HCP and patient should complete form and return via fax to 8775481734

•Proof of income is required, either by electronic income verification or by submitting documentation (copy of most recent federal tax return, W2 form(s), 1099 form, Social Security Award Letter or Check, or copies of three most recent pay stubs)

•Call 8444968707, MondayFriday, 8:00 am to 8:00 pm ET for more information

Enrollment Forms

Enrollment Form