RxAssist Home
RxAssist Home Home  |  About Us  |  Contact RxAssist          
      Patient Assistance Program Center

Program Details

Pfizer Patient Assistance Program

Lyrica (pregabalin)
Address: P.O. Box 8509
Somerville, NJ 08876
Phone: 1-866-706-2400 Provider Phone:
Fax: 1-866-470-1748 Website: Program Website
Eligibility Info:
  • To apply, please visit the program interactive forms at: Pfizer RxPathways
  • The Pfizer Patient Assistance Program provides eligible patients with select Pfizer medicines for free. To qualify:
  • Patients must not have any prescription drug coverage, or not enough coverage to pay for their Pfizer medicines.
  • Patients must meet program income guidelines, which vary by product and household size.
  • Patients must reside in the US or any of the US territories.
  • 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
    Attachments Required: Financial
    If requesting Lyrica - send copy of photo id and prescription must be signed by MD/DO.
    Physician License #
    Either DEA or State
    Prescriber Signature
    Application may be
    Eligibility determination
    letter sent:
    Both Provider and Patient
    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: Varies
    Other Information:

    Last Updated: 12/16/2021




    Application Forms
    & Instructions

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


    Print-friendly version

    This information is for informational purposes only and is not meant to be a substitute for professional medical advice, diagnosis or treatment. Neither RxAssist nor RxVantage is offering advice, recommending or endorsing any specific prescription drug, pharmacy or other information on the site. Neither RxVantage nor RxAssist provide any warranty for any of the pricing data or other information. Please seek medical advice before starting, changing or terminating any medical treatment. Third party logos, trademarks, brand names and images contained on rxassist.org or rxvantage.com are for demonstration purposes only and are owned by their respective rights holders, who are not affiliated with this Site.

    Copyright © 2022, RxVantage, all rights reserved.