Program Details
PFIZER, INC.
Pfizer Hemophilia Connect
Xyntha
(antihemophiliam factor (recombinant))
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CONTACT
INFO |
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Address: |
, |
Phone: |
1-844-989-4366 |
Provider Phone: |
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Fax: |
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Website: |
Program Website |
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ELIGIBILITY
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Eligibility
Info: |
Patient must not have prescription coverage for the medication.
Meet program income guidelines which are not disclosed.
Co-payment assistance, reimbursement support, and patient assistance programs are available for eligible patients. |
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Couple |
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% 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:
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Not
Published |
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APPLICATION |
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Attachments
Required: |
Not Published
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Physician
License #
Required: |
Not Published
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Prescriber
Signature
Allowed: |
Physician
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Application
may be
faxed: |
Yes
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Eligibility
determination
letter sent: |
Not Published
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MEDICATION |
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Receives: |
Medication
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Shipped To: |
Either Provider and Patient
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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
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Refill Policy: |
Contact program for details |
Other Information: |
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Last Updated: 04/29/2024
www.RxAssist.org
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