Pfizer Trial Prescription Program: Xyntha

Funded

About

The Pfizer Trial Prescription Program: Xyntha offers patients a unique opportunity to access the drug Xyntha for a trial period. The program is designed to support commercially insured patients, providing up to 20,000 IU of Xyntha at no cost. This initiative is ideal for first-time users and aims to ease the financial burden by ensuring the medicine is delivered directly to the patient's home.

Insurance requirements: Commercially insured, Underinsured

Enrollment Forms

Enrollment Form

Benefits

•1 maximum fills per year

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

•Patient's physician must fax completed form, along with the prescription for Xyntha and the patient authorization form, to 18888688660 (fax must be sent from a health care provider’s office)

•Documents can also be mailed to: Pfizer Factor Product Trial Prescription Program Administrator, MedVantx, PO Box 5736, Sioux Falls, SD 571175736

•1 to 3 weeks after submission of forms, eligible patients will receive up to 20,000 IU of Xyntha shipped directly to their home

•Offer expires 1 month from enrollment date or when the maximum benefit up to 20,000 IU at no cost has been reached

•Offer cannot be combined with any other rebate/coupon, free trial, or similar offer for the prescribed prescription

•Offer is not valid for prescriptions that are eligible to be reimbursed by private insurance plans or health or pharmacy benefit programs that reimburse for the entire cost of prescription drugs

•Offer will only be accepted by participating factor providers

•Only 1 offer per person and expires 1 month from enrollment date or when the maximum benefit up to 20,000 IU at no cost has been reached

•Call 8449894366 for assistance or additional information

Enrollment Forms

Enrollment Form