XALKORI <strong>Financial Assistance</strong>
Select an insurance status
Resources for eligible commercial, private, employer, and state health insurance marketplace coverage
Eligible, commercially insured patients may pay as little as $0 per month for XALKORI. Limits, terms, and conditions apply.*
Enrollment is simple, with no income requirements, forms, or faxing.
Help identifying resources for patients with Medicare/Medicare Part D, Medicaid, and other government insurance plans
- Assistance with searching for financial support that may be available from independent charitable foundations. These foundations exist independently of Pfizer and have their own eligibility criteria and application processes. Availability of support from the foundations is determined solely by the foundations
- Financial assistance through Extra Help, a Medicare Part D Low-Income Subsidy (LIS) program
- Free medicine†
Help identifying resources for patients who do not have any form of healthcare coverage
- Help finding coverage
- Free medicine through the Pfizer Patient Assistance Program, or at a savings through the Pfizer Savings Program‡
Terms and Conditions
By enrolling in this co-pay offer, you acknowledge that you currently meet the eligibility criteria and will comply with the Terms and Conditions described below:
- Patients are not eligible to use this card if they are enrolled in a state or federally funded insurance program, including but not limited to Medicare, Medicaid, TRICARE, Veterans Affairs health care, a state prescription drug assistance program, or the Government Health Insurance Plan available in Puerto Rico (formerly known as “La Reforma de Salud”).
- Patient must have private insurance. Offer is not valid for cash-paying patients.
- With this card, eligible patients will pay a $0 co-pay per eligible monthly prescription, subject to a maximum amount of $25,000 per product per calendar year. The amount of any benefit is the difference between your co-pay and $0. After the annual maximum of $25,000 per product is reached, you will be responsible for the remaining monthly out-of-pocket costs. This card may not be redeemed more than once per 30 days. The average benefit is $924.21 per patient per year.
- This co-pay card is not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private insurance plan or other private health or pharmacy benefit programs.
- You must deduct the value of this co-pay card from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf.
- You are responsible for reporting use of the co-pay card to any private insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the co-pay card, as may be required. You should not use the co-pay card if your insurer or health plan prohibits use of manufacturer co-pay cards.
- This co-pay card is not valid where prohibited by law.
- Card cannot be combined with any other savings, free trial, or similar offer for the specified prescription.
- Card will be accepted only at participating pharmacies.
- This card is not health insurance.
- Offer good only in the U.S. and Puerto Rico.
- Card is limited to 1 per person during this offering period and is not transferable.
- No other purchase is necessary.
- Data related to your redemption of the co-pay card may be collected, analyzed, and shared with Pfizer for market research and other purposes related to assessing Pfizer’s programs. Data shared with Pfizer will be aggregated and de-identified; it will be combined with data related to other co-pay card redemptions and will not identify you.
- Pfizer reserves the right to rescind, revoke, or amend this offer without notice.
- Offer expires 6/30/2022.
If your pharmacy does not participate, you may be able to submit a request for a rebate in connection with this offer. Mail a copy of the patient’s pharmacy receipt indicating patient name, name of medication purchased, price paid, and date purchased, along with a copy of the patient’s Pfizer Oncology Together Co-Pay Savings Card, to:
Pfizer Oncology Together Co-Pay Savings Program
2250 Perimeter Park Drive, Suite 300
Morrisville, NC 27560