Program Details
PFIZER, INC.
Pfizer Dermatology Patient Access
Cibinqo
(abrocitinib tablet)
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CONTACT
INFO |
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Address: |
, |
Phone: |
1-844-496-8707 |
Provider Phone: |
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Fax: |
1-877-548-1734 |
Website: |
Program Website |
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ELIGIBILITY
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Eligibility
Info: |
Program eligibility not disclosed, please contact the program to determine eligibility.
Program offers co-pay assistance, patient support, and patient assistance programs for eligible patients.
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Couple |
|
% FPL |
Income at or below: |
Not
Published |
Medical expenses
can be deducted from reported income: |
Not
Published |
Social security requested on form: |
No |
US citizenship/residency specified:
|
Yes |
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APPLICATION |
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Attachments
Required: |
Financial
|
Physician
License #
Required: |
Both DEA and State
NPI
|
Prescriber
Signature
Allowed: |
Physician
|
Application
may be
faxed: |
Yes
|
Eligibility
determination
letter sent: |
Both Provider and Patient
|
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MEDICATION |
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Receives: |
Not Published
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Shipped To: |
Not Published
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Quantity in
Shipment: |
Not Published
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Delivery Time: |
Not Published
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Re-application
Policy: |
New application every 12 months
New financial information every 12 months
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Refill Policy: |
Not Published
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Other Information: |
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Last Updated: 04/29/2024
www.RxAssist.org
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