PFIZER PATIENT ASSISTANCE PROGRAM* PATIENT APPLICATION Phone 1-844-XELJANZ (1-844-935-5269) • Fax 1-866-297-3471 • 2730 S. Edmonds Lane, Suite 300, Lewisville, TX 75067 Please complete the form where applicable and return via mail or fax. Pages 1 and 3 must be returned to XELSOURCE.
Full Answer
How can I get help with Pfizer prescription assistance?
Pfizer has been helping patients gain access to the Pfizer medicines they need for more than 25 years. Through Pfizer RxPathways, Pfizer can also help connect patients to other assistance services the company offers if they are not eligible to receive their medicines for free. These programs include:
How do I apply for Pfizer rxpathways?
Patients, health care providers and patient advocates can visit www.PfizerRxPathways.com to learn more about Pfizer’s programs, including eligibility criteria and how to apply, and to download applications or program brochures. Pfizer RxPathways is a joint program of Pfizer Inc. and the Pfizer Patient Assistance Foundation™.
How do I enroll patients in xelsource HCP?
Contact your Pfizer Representative to be put in touch with your FRM See how the XELSOURCE HCP Portal streamlines the enrollment processFind out more about XELSOURCEForms and resources to help eligible patients access their prescribed medicationXELSOURCE Prescription and Enrollment Form Complete, print, and fax to enroll patients in XELSOURCE.
Is the Pfizer Patient Assistance Foundation a legal entity?
The Pfizer Patient Assistance Foundation is a separate legal entity from Pfizer Inc., with distinct legal restrictions. Please see Indication and Important Safety Information on page 2. Click here for full Prescribing Information, including BOXED WARNING and Medication Guide.
What are the most common adverse reactions to Xeljanz?
What does XELJANZ XR look like?
Does XELJANZ inhibit gastrointestinal perforation?
Can Xeljanz cause TB?
Can XELJANZ XR be administered with strictures?
Does Pfizer have a patient assistance program?
Pfizer RxPathways® patients in need get access to their Pfizer medicines. Today, Pfizer RxPathways® connects eligible U.S. patients to a range of Pfizer assistance programs that provide insurance support, co-pay help, and medicines for free or at a savings.
What is Xelsource?
Psoriatic Arthritis. • XELJANZ/XELJANZ XR (tofacitinib) is indicated for the treatment of adult patients with active psoriatic arthritis who have had an inadequate response or intolerance to methotrexate or other disease-modifying antirheumatic drugs (DMARDs).
What is xeljanz used for?
XELJANZ (tofacitinib) is the first approved pill of its kind (JAK inhibitor) that treats adults with moderate to severe rheumatoid arthritis, active psoriatic arthritis, active ankylosing spondylitis, and moderate to severe ulcerative colitis.
Does Mylan have a patient assistance program?
Additional information about the Mylan EpiPen® (epinephrine injection, USP) Auto-Injector Patient Assistance Program is available by calling 800.796. 9526.
Does tofacitinib cause hair loss?
Official answer. Hair loss is not a side effect of Xeljanz (tofacitinib citrate), according to the results of clinical trials used to gain approval of the drug. During clinical development, hair loss was not reported as an adverse effect.
How do I get Rinvoq?
Just give us a call at 1.800. 2RINVOQ (1.800. 274.6867). Eligibility: Available to patients with commercial prescription insurance coverage for RINVOQ™ (upadacitinib) who meet eligibility criteria.
Is Xeljanz Pfizer?
About XELJANZ® (tofacitinib) As the developer of XELJANZ, Pfizer is committed to advancing the science of JAK inhibition and enhancing understanding of this medicine through robust clinical development programs in the treatment of immuno-inflammatory conditions.
How long can you stay on Xeljanz?
Ulcerative Colitis Xeljanz 10 mg twice daily for at least eight weeks; then 5 mg twice daily. A higher dose of 10 mg twice daily can be continued for a total of 16 weeks, depending on response.
What is the new drug for arthritis?
A drug used to treat rheumatoid arthritis (RA) was approved this summer by the U.S. Food and Drug Administration (FDA). The medication, known as baricitinib, is expected to be available sometime this fall. The oral pill is taken once a day.
Does Viatris have a patient assistance program?
The Viatris Patient Assistance Program provides certain medicines for free to patients with demonstrated financial need. Viatris is committed to helping patients get the treatments they need, when and where they need them.
How do people afford MS treatment?
There are some national foundations that provide help for people with MS. They include NeedyMeds, The Patient Access Network Foundation and Chronic Disease Fund. Social Security Disability Insurance is available for people who are unable to work, but are entitled to receive disability benefits.
What is Viatris advocate?
The Viatris Advocate platform offers support and resources for patients, their caregivers and their healthcare providers.
What are the side effects of taking Xeljanz?
The most common side effects of Xeljanz include upper respiratory tract infection, cold-like symptoms, diarrhea, rash, herpes zoster infection (shingles) and headache. The medication can also cause more severe problems such as serious infections, heart problems, cancer, blood clots, and death.
What is the difference between Humira and Xeljanz?
Xeljanz and Humira belong to different drug classes. Xeljanz is a Janus kinase (JAK) inhibitor and Humira is a tumor necrosis factor (TNF) blocker. Side effects of Xeljanz and Humira that are similar include headache and stuffy nose.
Who should not take Xeljanz?
chronic kidney disease stage 4 (severe) chronic kidney disease stage 5 (failure) kidney disease with likely reduction in kidney function. an increased risk of developing an uncommon viral infection called an opportunistic infection.
Does Xeljanz cause weight gain?
Does Xeljanz cause weight gain or weight loss? No, Xeljanz and Xeljanz XR don't lead to weight gain or weight loss. But serious side effects of these drugs or your condition itself may cause unexplained weight loss. For example, weight loss can be seen with diarrhea, serious infection, and cancer.
XELSOURCE Patient Assistance Program Application - Pfizer pro
1 PATIENT APPLICATION PFIZER PATIENT ASSISTANCE PROGRAM* Phone 1-844-935-5269 | Fax 1-866-297-3471 | 2730 S. Edmonds Lane, Suite 300, Lewisville TX 75067
XELSOURCE Patient Assistance Program Application - Pfizer pro
1 Patient Declaration – By signing below, I affirm that my answers and my proof-of-income documents are complete, true, and accurate to the best of my knowledge. I understand that: • Completing this application form does not guarantee that I will qualify for the Pfizer Patient Assistance Program.
PATIENT ASSISTANCE APPLICATION FOR XELJANZ® (tofacitinib ... - RxHope
Patient Declaration – By signing below, I affirm that my answers and my proof-of-income documents are complete, true, and accurate to the best of my knowledge. I understand that: • Completing this application form does not guarantee that I will qualify
Get Xelsource Patient Portal - US Legal Forms
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What is XELSOURCE support?
Use XELSOURCE support programs to help your eligible patients receive their XELJANZ treatment after a prescribing decision is made.
What setting of care must a patient be treated in?
Patient must be treated in the outpatient setting of care.
Can Pfizer revoke a program?
Pfizer reserves the right to rescind, revoke, or amend the program without notice.
Can you combine a prescription card with a savings card?
The Card cannot be combined with any other savings, free trial, or similar offer for the specified prescription.
Is the offer valid for cash paying patients?
Patient must have private insurance. Offer is not valid for cash-paying patients.
Is Pfizer a health insurance?
The Pfizer Patient Assistance Program is not health insurance and is available for eligible uninsured/underinsured patients only.
How much does Pfizer cost?from drugs.com
The cost for Pfizer-BioNTech COVID-19 Vaccine intramuscular suspension (30 mcg/0.3 mL) is around $10 for a supply of 45 milliliters, depending on the pharmacy you visit. Prices are for cash paying customers only and are not valid with insurance plans.
How long can Pfizer thaw?from cdc.gov
Vaccine may be thawed in the refrigerator or at room temperature. Refrigerator: Between 2°C and 8°C (36°F and 46°F) Unpunctured vials can be stored in the refrigerator for up to 1 month (31 days).
How much does a free drug card save?from drugs.com
The free Drugs.com Discount Card works like a coupon and can save you up to 80% or more off the cost of prescription medicines, over-the-counter drugs and pet prescriptions.
What is the use of CDC's beyond use date label?from cdc.gov
Use CDC’s beyond-use date labels for this vaccine to track storage time at refrigerated and frozen temperatures.
What is Pfizer access counseling?
Medicine access counseling to help patients get connected to the appropriate Pfizer assistance program
What is Pfizer Rxpathways?
Pfizer RxPathways is a joint program of Pfizer Inc. and the Pfizer Patient Assistance Foundation™.
What is Pfizer's mission?
At Pfizer, we apply science and our global resources to bring therapies to people that extend and significantly improve their lives. We strive to set the standard for quality, safety and value in the discovery, development and manufacture of health care products. Our global portfolio includes medicines and vaccines as well as many of the world's best-known consumer health care products. Every day, Pfizer colleagues work across developed and emerging markets to advance wellness, prevention, treatments and cures that challenge the most feared diseases of our time. Consistent with our responsibility as one of the world's premier innovative biopharmaceutical companies, we collaborate with health care providers, governments and local communities to support and expand access to reliable, affordable health care around the world. For more than 150 years, Pfizer has worked to make a difference for all who rely on us. To learn more, please visit us at www.pfizer.com.
What is a copay card?
Co-pay cards for those with private/commercial insurance and information on alternate sources of help, like independent co-pay foundations
Does Pfizer give free prescriptions?
With this change, more than 40 medicines offered for free through the program will now be available to eligible patients earning up to 4 times the Federal Poverty Level (FPL) adjusted for family size ($47,080 for a single person; $97,000 for a family of four).
What is Pfizer Patient Assistance Program?
Pfizer Patient Assistance Program. Provides free Pfizer medicines to eligible patients through their doctor’s office or at home. To qualify, patients must: Have a valid prescription for the Pfizer medicine for which they are seeking assistance. Have no prescription coverage, or not enough coverage, to pay for their Pfizer medicine.
What is Pfizer Savings Program?
Pfizer Savings Program. Helps uninsured patients receive savings on more than 100 Pfizer medicines directly at their pharmacy, regardless of their income. Call 1-855-239-9869 to enroll. View available medicines.
How many Pfizer medicines are free?
The Pfizer Patient Assistance Program provides more than 60 Pfizer medicines for free to eligible patients through their doctor’s office, or in some cases, through home delivery.
What is the Pfizer phone number?
Patients can dial the toll-free phone number 1-844-989-PATH (7284) to consult with a Pfizer Medicine Access Counselor to find out if they meet the eligibility requirements.
How to contact Pfizer Rxpathways?
For more information about Pfizer RxPathways, please visit www.PfizerRxPathways.com. Patients can also call the toll-free phone number 1-844-989-PATH (7284) to consult with a Pfizer Medicine Access Counselor.
How to be evaluated for Pfizer?
To be evaluated for assistance, patients and their healthcare providers must submit a completed enrollment form. Patients must also provide proof of income, such as a W2 form, a paycheck stub, or prior year’s tax return. In some cases, patients prescribed certain Pfizer medicines may first be required to seek alternate forms of assistance before they can be considered for free medicine through the Pfizer Patient Assistance Program.
Can underinsured patients get free Pfizer?
Both uninsured and underinsured patients may be eligible for help. To qualify for free medicine through the Pfizer Patient Assistance Program, patients must*:
What is Pfizer IGuide?
Pfizer IGuide provides reimbursement and financial assistance to eligible patients who have been prescribed Panzyga or Cutaquig.
What is Myfembree support?
The Myfembree ® Support Program is designed to help your patients throughout their treatment journey. We offer financial assistance options, dedicated support staff, and other helpful resources once patients have been prescribed Myfembree ®.
What is a copay assist?
Assists eligible patients with their co-pay costs .
What are the most common adverse reactions to Xeljanz?
The most commonly reported adverse reactions during the first 3 months in controlled clinical trials with XELJANZ 5 mg twice daily and placebo, respectively, (occurring in greater than or equal to 2% of patients treated with XELJANZ with or without DMARDs) were upper respiratory tract infections (4.5%, 3.3%), headache (4.3%, 2.1%), diarrhea (4.0%, 2.3%), and nasopharyngitis (3.8%, 2.8%).
What does XELJANZ XR look like?
When you take XELJANZ XR, you may see something in your stool that looks like a tablet. This is the empty shell from the tablet after the medicine has been absorbed by your body.
Does XELJANZ inhibit gastrointestinal perforation?
Gastrointestinal perforations have been reported in XELJANZ clinical trials, although the role of JAK inhibition is not known. XELJANZ/XELJANZ XR should be used with caution in patients who may be at increased risk for gastrointestinal perforation (e.g., patients with a history of diverticulitis).
Can Xeljanz cause TB?
XELJANZ/XELJANZ XR may cause serious side effects, including:Serious infections. XELJANZ/XELJANZ XR can lower the ability of your immune system to fight infections. Some people can have serious infections while taking XELJANZ/XELJANZ XR, including tuberculosis (TB), and infections caused by bacteria, fungi, or viruses that can spread throughout the body. Some people have died from these infections. Your healthcare provider should test you for TB before starting and during XELJANZ/XELJANZ XR treatment, and monitor you closely for signs and symptoms of TB infection during treatment. You should not start taking XELJANZ/XELJANZ XR if you have any kind of infection unless your healthcare provider tells you it is okay.
Can XELJANZ XR be administered with strictures?
Caution should be used when administering XELJANZ XR to patients with pre-existing severe gastrointestinal narrowing. There have been rare reports of obstructive symptoms in patients with known strictures in association with the in gestion of other drugs utilizing a non-deformable extended release formulation.