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Program Details

PFIZER, INC.
Pfizer RxPathways

Lyrica (pregabalin)
 
CONTACT INFO
Address: PO Box 66585
St. Louis, MO 63166-6585
Phone: 1-866-706-2400 Provider Phone:
Fax: 1-866-470-1748 Website: Program Website
ELIGIBILITY
Eligibility Info:
  • Patients must not have any prescription drug coverage, or not enough coverage to pay for their Pfizer medicines.
  • Patients must meet program income guidelines.
  • Patients must reside in the US, Puerto Rico, or the USVI.
  • Income at or below: Not Published
    Other Income Requirements:
  • Income varies by medication needed.
  • Adjusted for family size.
  • NOTE: If patient has no income and does not file taxes, a letter from the physician stating the patient has no income OR a notarized letter from a family member is required.
  • Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: No
    US citizenship/residency specified: Yes
    APPLICATION
    Attachments Required: Financial
    If requesting Lyrica - send copy of photo id and prescription must be signed by MD/DO.
    Physician License #
    Required:
    Either DEA or State
    Prescriber Signature
    Allowed:
    Physician
    Application may be
    faxed:
    Yes
    Eligibility determination
    letter sent:
    Both Provider and Patient
    MEDICATION
    Receives: Medication
    Shipped To: Provider
    Note: Lyrica, oral oncology, and specialty products are shipped to the patient's home
    Quantity in Shipment: 90 days
    Delivery Time: 2-4 weeks
    Re-application Policy: New application every 12 months
    New financial information every 12 months
    Refill Policy: Re-orders can be placed by the HCP online via www.PfizerPAP.com, or through Pfizer RxPathways automated phone re-ordering system at 855-742-7497
    Other Information: For help with Prevnar 13, please contact customer service and talk to you health care provider.

    Last Updated: 05/06/2014

     

     

     


    Application Forms
    & Instructions

    The following documents are provided in interactive PDF format, allowing you to type information directly into the form.


    Document Enrollment Form - Group A Medicines


    Document Enrollment Form - Group B Medicines


    Document Enrollment Form - Group C Medicines



     

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