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
Help identifying resources for patients who do not have any form of healthcare coverage
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:
Pfizer Oncology Together Co-Pay Savings Program
2250 Perimeter Park Drive, Suite 300
Morrisville, NC 27560
As part of its commitment, Pfizer is proud to offer the Pfizer Pledge Warranty Program for XALKORI (the “Program”).§ With this program, eligible patients can get their out-of-pocket costs for XALKORI refunded. See below for requirements. Pfizer Pledge is available to cash, commercial (those with employer-sponsored or private insurance), and Medicare Part D patients who discontinue XALKORI before the fourth 30-day supply is dispensed.
§Terms and Conditions apply.
You are eligible if:
Please refer to the Terms and Conditions to learn more.
The Pfizer Pledge Warranty Program for XALKORI will refund eligible patients’ out-of-pocket costs as follows:
If your first 30-day supply of XALKORI is dispensed on or after June 1, 2021, and you discontinue therapy before your fourth refill is dispensed, you may be eligible to receive a warranty payment. Following these 2 easy steps when you are purchasing XALKORI will make the process easier should you need to file a warranty claim:
Although you can obtain this documentation after starting XALKORI, it is suggested that you gather it when starting treatment.
Please download, fill out, and submit this form to start the reimbursement process. If you have questions, call 1-866-330-7902 Monday-Friday, 7 AM-7 PM CT for assistance.Download
Please read, sign, and submit this form. It is needed to process your claim.Download
Please give this form to your healthcare provider to fill out.Download
Please review the Terms and Conditions carefully before initiating the reimbursement process.
Pfizer, Inc. (referred to as "us", "we" and similar terms) is proud to offer the Pfizer Pledge Warranty Program for XALKORI (the "Program") to each Patient (referred to as "you", "your" and similar terms) who meets the Eligibility Requirements and follows the Program Procedures described below, subject to all of the terms and conditions in this document (the "Terms"). You should carefully review these Terms.
For Patients who meet the Eligibility Requirements, Pfizer will refund the out-of-pocket amount that you paid for up to the first three (3) bottles (30-day supply) of XALKORI, up to a maximum of $19,144 for each bottle (30-day supply) or an aggregate maximum of up to $57,432 (the “Maximum”). If your commercial insurance or Medicare and/or other payers (“Your Plan(s)”) paid for all or a portion of the cost of XALKORI, Pfizer will, on your behalf, refund to Your Plan(s) up to the Maximum that Your Plan(s) paid, less documented copayments provided by you. Payments to all parties must be equal to or less than the cost paid by each party and may reset Your Plan(s)’s out-of-pocket deductible and/or true out-of-pocket (“TrOOP”) cost in accordance with Your Plan(s)’s benefit design and Medicare requirements. The order of priority of warranty payments is first to you and then to Your Plan that is primary and then to Your Plan(s) that are secondary as determined by information provided by you and documented proof of payment that you provide to us. You are responsible for submitting proof of payment for you and for Your Plan(s). All claims payments will be reported to Your Plan(s) and to Medicare as required by law.
In order for you to be eligible to use the Program, you must satisfy all of the criteria listed below:
In order to be eligible for a refund under this Program, you must satisfy the requirements and submit the information below (the “Claims Information”), within one hundred and twenty (120) days following the dispense date of your last bottle (30-day supply) of XALKORI.
By submitting your Claims Information under the Program, you are representing and warranting that you took the medication in accordance with the Instructions that were provided by your prescribing physician.
LIMITATION OF LIABILITY
IN NO EVENT, UNDER ANY CAUSE OF ACTION OF THEORY OF LIABILITY, SHALL PFIZER, ITS DISTRIBUTORS OR SUPPLIERS BE LIABLE TO YOU OR ANY THIRD PARTY FOR ANY INDIRECT, INCIDENTAL, CONSEQUENTIAL, SPECIAL, EXEMPLARY OR PUNITIVE DAMAGES, OF ANY NATURE WHATSOEVER, ARISING OUT OF OR IN CONNECTION WITH THE PROGRAM, EVEN IF PFIZER HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.
NOTWITHSTANDING ANY DAMAGES THAT YOU MIGHT INCUR FOR ANY REASON WHATSOEVER INCLUDING, WITHOUT LIMITATION, ALL DAMAGES REFERENCED HEREIN AND ALL DIRECT OR GENERAL DAMAGES IN CONTRACT, TORT (INCLUDING NEGLIGENCE) OR OTHERWISE, THE ENTIRE AGGREGATE LIABILITY OF PFIZER AND ANY OF ITS DISTRIBUTORS AND/OR SUPPLIERS SHALL BE LIMITED TO THE MAXIMUM AMOUNT SET FORTH ABOVE FOR THE PRODUCT THAT IS SUBJECT TO THE PROGRAM. SOME STATES AND/OR JURISDICTIONS DO NOT ALLOW THE EXCLUSION OR LIMITATION OF INCIDENTAL OR CONSEQUENTIAL DAMAGES, SO THE ABOVE LIMITATIONS OR EXCLUSIONS MAY NOT APPLY TO YOU. THE LIMITATIONS OF LIABILITY SET FORTH ABOVE SHALL APPLY TO THE MAXIMUM EXTENT PERMITTED UNDER APPLICABLE LAW.
ARBITRATION: Read the following arbitration provision (“Provision”) carefully. It limits certain of your rights, including your right to obtain relief or damages through court action.
To begin Arbitration, either you or we must make a written demand to the other party for arbitration for the applicable claim ("Claim"). The Arbitration will take place before a single arbitrator. It will be administered in keeping with the Expedited Procedures of the Commercial Arbitration Rules ("Rules") of the American Arbitration Association ("AAA") in effect when the Claim is filed. You may get a copy of these AAA's Rules by visiting www.adr.org. The filing fees to begin and carry out arbitration will be shared equally between you and us. This does not prohibit the arbitrator from giving the winning party their fees and expenses of the arbitration. Unless you and we agree, the arbitration will take place in the county and state where you live. The Federal Arbitration Act, 9 U.S.C. Ch. 1, et seq., will govern and not any state law on arbitration. YOU AGREE AND UNDERSTAND THAT this arbitration provision means that you give up your right to go to court on any Claim covered by this provision. You also agree that any arbitration proceeding will only consider your Claim. Claims by, or on behalf of, other individuals will not be arbitrated in any proceeding that is considering your Claims. THE DEGREE TO WHICH ARBITRATION CAN BE USED AS A DISPUTE RESOLUTION PROCESS FOR CONSUMER CLAIMS VARIES FROM STATE TO STATE, SO THIS ARBITRATION PROVISION MAY NOT APPLY TO YOU, DEPENDING ON YOUR STATE OF RESIDENCE. In the event this Arbitration provision is not approved by the appropriate state regulatory agency, and/or is stricken, severed, or otherwise deemed unenforceable by a court of competent jurisdiction, you and us specifically agree to waive and forever give up the right to a trial by jury. Instead, in the event any litigation arises between you and us, any such lawsuit will be tried before a judge, and a jury will not be impaneled or struck.