CONTACT
INFO |
|
Address: |
, |
Phone: |
1-800-645-1280 |
Provider Phone: |
|
Fax: |
1-800-479-2562 |
Website: |
Program Website |
|
ELIGIBILITY
|
|
Eligibility
Info: |
Determined on case-by-case basis, call for prescreening.
Patients with Medicare Part D may be eligible, contact program for details.
|
Income at or below: |
Single |
|
500
% FPL |
|
Couple |
|
500
% FPL |
Income at or below: |
Not
Published |
Medical expenses
can be deducted from reported income: |
Not
Published |
Social security requested on form: |
Not
Published |
US citizenship/residency specified:
|
Yes |
|
APPLICATION |
|
Attachments
Required: |
Not Published
|
Physician
License #
Required: |
Not Published
|
Prescriber
Signature
Allowed: |
Physician
|
Application
may be
faxed: |
Yes
|
Eligibility
determination
letter sent: |
Both Provider and Patient
|
|
MEDICATION |
|
Receives: |
Medication
|
Shipped To: |
Patient
|
Quantity in
Shipment: |
Varies |
Delivery Time: |
Not Published
|
Re-application
Policy: |
New application every 12 months
|
Refill Policy: |
Program will contact patient |
Other Information: |
Applications cannot be downloaded from the product sites. The physician can call the Pfizer Bridge Program at (800) 645-1280 to initiate the reimbursement and/or patient assistance process. |
|