How do I apply for the Xeljanz Patient Assistance Program?
XELSOURCE Patient Assistance Program Application 1 Phone 1-844-XELJANZ (1-844-935-5269) • Fax 1-866-297-3471 • 2730 S. Edmonds Lane, Suite 300, Lewisville, TX 75067 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.
What is the Pfizer Patient Assistance Program?
The Pfizer Patient Assistance Program is a joint program of Pfizer Inc. and the Pfizer Patient Assistance Foundation Inc. The Pfizer Patient Assistance Foundation is a separate legal entity from Pfizer Inc., with distinct legal restrictions.
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.
When should anti-TB therapy be considered prior to administration of Xeljanz XR?
Consider anti-TB therapy prior to administration of XELJANZ/XELJANZ XR in patients with a past history of latent or active TB in whom an adequate course of treatment cannot be confirmed, and for patients with a negative test for latent TB but who have risk factors for TB infection.
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?
See 2 more
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 Pfizer patient assistance program?
The Pfizer Patient Assistance Program provides certain medicines for free to eligible financially needy insured and uninsured patients. English.
Is patient assistance program legitimate?
Patient assistance programs (PAPs) are usually sponsored by pharmaceutical manufacturers and are promoted as a safety net for Americans who have no health insurance or are underinsured.
Does Roche have a patient assistance program?
For patients who cannot afford certain drugs. Call for information.
How do you qualify for free eliquis?
You may be eligible for the Free 30-Day Trial Offer for ELIQUIS® (apixaban) if:You have not previously filled a prescription for ELIQUIS;You have a valid 30-day prescription for ELIQUIS;You are being treated with ELIQUIS for an FDA-approved indication that an HCP has planned for more than 35 days of treatment;More items...
What is Pfizer enCompass?
Pfizer enCompass offers various services to patients including reimbursement support for insured patients; co-pay assistance for eligible commercially insured patients who cannot afford their co-pays, co-insurances, or deductibles; and a free medicine patient assistance program for eligible uninsured or underinsured ...
How do patient support programs work?
A patient assistance or support programs (PAPs or PSPs) exist to get you timely access to medication and to help you stay on track of your therapy. Being diagnosed with a complex disease or condition may come with unexpected financial burden and a need to better understand treatment options and next steps.
What sources of assistance are available for medical and prescription needs?
There are several ways you can get help paying for your prescription medicine.Private and public health insurance. Many people have health insurance. ... State and community programs. Some state governments offer affordable medicine programs. ... Private programs. ... Patient-assistance programs. ... For more information.
Can you use copay assistance with Medicare?
The Patient Advocate Foundation (PAF) Co-Pay Relief Program (CPR) provides direct financial support for pharmaceutical co-payments to insured patients, including Medicare Part D beneficiaries, who financially and medically qualify.
What is AbbVie patient assistance program?
myAbbVie Assist provides free medicine to qualifying patients. If you are uninsured or have limited insurance coverage, you may be eligible to receive prescribed AbbVie medication at no cost from our Program.
Does AbbVie have a patient assistance program?
We believe that people who need our medicines should be able to get them. That's why myAbbVie Assist provides free AbbVie medicine to qualifying patients. If you have any questions, visit the FAQs or call us at 1-800-222-6885. AbbVie is committed to helping patients get the medicines they need.
Who makes mycophenolic?
by Apotex. Founded in 1974, Apotex Inc. is Canada's largest pharmaceutical maker and distributes about 300 drugs in the U.S. Apotex serves 100 countries through its range of product offerings.
What is Pfizer Oncology together?
Pfizer Oncology Together is a personalized patient support program that offers resources for patients prescribed Pfizer Oncology medicines. We provide access and reimbursement support, as well as help identifying financial assistance options, so patients can get their prescribed Pfizer Oncology medicines.
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.
Does Pfizer make metoprolol?
metoprolol tartrate injection, USP - VIAL | Pfizer Medical Information - US.
PFIZER Patient Assistance Program Form
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.
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.
Get Xelsource Patient Portal - US Legal Forms
USLegal has been awarded the TopTenREVIEWS Gold Award 9 years in a row as the most comprehensive and helpful online legal forms services on the market today. TopTenReviews wrote "there is such an extensive range of documents covering so many topics that it is unlikely you would need to look anywhere else".
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
New Patient Application
New Patient Application READ BELOW TO SEE IF THIS PROGRAM IS RIGHT FOR YOU. WHO MAY BE ELIGIBLE To be eligible for Connection to Care: o Your total family household income must be at or below 200% of the Federal Poverty Level.
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 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.
Does interim care require purchase?
Interim Care Rx offer does not require, nor will be made contingent on, purchase requirements of any kind.
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.
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.
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 anaphylaxis after a previous dose?from cdc.gov
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of an mRNA COVID-19 vaccine (Moderna or Pfizer-BioNTech) Immediate allergic reaction † of any severity to a previous dose or known (diagnosed) allergy to a component of the vaccine.
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.
What are the most common adverse reactions to Xeljanz?
The most common serious adverse reactions were serious infections. The most commonly reported adverse reactions during the first 3 months in controlled clinical trials in patients with rheumatoid arthritis (RA) 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 infection, nasopharyngitis, diarrhea, headache, and hypertension. The safety profile observed in patients with active psoriatic arthritis treated with XELJANZ was consistent with the safety profile observed in RA patients.
What is XELJANZ XR?
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 are the side effects of Xeljanz?
Your healthcare provider may do blood tests before you start treatment with XELJANZ/XELJANZ XR and while you are using XELJANZ/XELJANZ XR. Tell your healthcare provider if you have any of the following symptoms of a possible hepatitis B or C infection: feel very tired, little or no appetite, clay-colored bowel movements, chills, muscle aches, skin rash, skin or eyes look yellow, vomiting, fevers, stomach discomfort, or dark urine.Common side effects of XELJANZ/XELJANZ XR in rheumatoid arthritis and psoriatic arthritis patients include upper respiratory tract infections (common cold, sinus infections), headache, diarrhea, nasal congestion, sore throat, and runny nose (nasopharyngitis), and high blood pressure (hypertension).
Can you take Xeljanz twice daily?
Use of XELJANZ/XELJANZ XR in patients with severe hepatic impairment is not recommended.For patients with moderate hepatic impairment or with moderate or severe renal impairment taking XELJANZ 5 mg twice daily, reduce to XELJANZ 5 mg once daily.For UC patients with moderate hepatic impairment or with moderate or severe renal impairment taking XELJANZ 10 mg twice daily, reduce to XELJANZ 5 mg twice daily.
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.
Can XELJANZ cause death?
Patients treated with XELJANZ/XELJANZ XR are at increased risk for developing serious infections that may lead to hospitalization or death. Most patients who developed these infections were taking concomitant immunosuppressants, such as methotrexate or corticosteroids.
Is Xeljanz XR safe for pregnancy?
Available data with XELJANZ/XELJANZ XR use in pregnant women are insufficient to establish a drug associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes. There are risks to the mother and the fetus associated with rheumatoid arthritis and UC in pregnancy. In animal studies, tofacitinib at 6.3 times the maximum recommended dose of 10 mg twice daily demonstrated adverse embryo-fetal findings. The relevance of these findings to women of childbearing potential is uncertain. Consider pregnancy planning and prevention for females of reproductive potential.
What are the most common adverse reactions to Xeljanz?from pfizerpro.com
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?from pfizerpro.com
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?from pfizerpro.com
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?from pfizerpro.com
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?from pfizerpro.com
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.
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.
