Pfizer Interim Care Rx Program: Velsipity

Funded

About

The Pfizer Interim Care Rx Program: Velsipity offers patients who are prescribed Velsipity the opportunity to receive medication at no cost for up to two years if they experience insurance delays or denials. This program supports eligible commercially insured patients by providing up to a 30-day supply, with potential renewals, to ensure access to treatment during prior authorization or appeal processes. Applicable only in the U.S. and Puerto Rico, except certain states, this program requires active pursuit of insurance coverage and appeals.

Insurance requirements: Commercially insured

Enrollment Forms

Enrollment Form

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: No

•Activation Required: No

Program Details

•Eligible commercially insured patients may receive up to 2 years of medication at no cost if there is an insurance delay or denial

•Available up to a 30day supply. To be eligible for an additional 30day refill, the patient must be actively pursuing coverage through their insurance awaiting a prior authorization/appeal decision or removal of a new to market block

•For patients awaiting removal of a new to market block from their insurance provider, Velsipity may be provided for up to 180 days

•Interim Care Rx for Velsipity may not exceed 2 years for any patient.

•Continued eligibility for the program requires submission of two appeals within 180 days of enrollment

•After 12 months of program enrollment, an updated prescription and benefits investigation is required to confirm continued eligibility

•Not available to residents in the states of Massachusetts, Michigan, Minnesota, or Rhode Island

•Call 8003503080, MondayFriday, 8AM8PM ET, for assistance or additional information

Enrollment Forms

Enrollment Form