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savings card

savings card
Pfizer Oncology Together

Eligible, commercially insured patients may pay as little as $0 a month for XALKORI® (crizotinib). Limits, terms, and conditions apply. See below for details.

Please select "yes" or "no" for the following questions. Your answers will determine your eligibility for the Pfizer Co-Pay One Program.

Please fill out the form below to access your Pfizer Co-Pay One Savings Card.

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CHECK YOUR ELIGIBILITY

Please select "yes" or "no" for the following questions. Your answers will determine your eligibility for the Pfizer Co-Pay One Program.

Eligible, commercially insured patients may pay as little as $0 a month for XALKORI® (crizotinib). Limits, terms, and conditions apply. See below for details.

To learn about other financial assistance options, click here to visit PfizerOncologyTogether.com,
or call 1-877-744-5675 for live support.

You are not eligible for the program at this time.

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:

  • This card is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, Tricare or other federal or state healthcare programs (including any state prescription drug assistance programs) and the Government Health Insurance Plan available in Puerto Rico (formerly known as “La Reforma de Salud”).
  • This card is not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private insurance plans or other health or pharmacy benefit programs.
  • With this card you will pay a $0 co-pay per eligible monthly prescription, subject to a maximum benefit of $25,000 per calendar year. The amount of any benefit is the difference between your co-pay and $0. After the maximum of $25,000 you will be responsible for the remaining monthly out-of-pocket costs. This card may be used once per 30 days until the maximum benefit has been reached. The average benefit is $924.21 per patient per year.
  • You must deduct the value of the benefit you receive with this card from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf.
  • This card is not valid where prohibited by law.
  • Card cannot be combined with any other rebate/coupon, 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.
  • Pfizer reserves the right to rescind, revoke or amend this offer without notice.
  • No membership fee.
  • Offer expires 12/31/2019.
  • For reimbursement when using a nonparticipating pharmacy: 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 Co-pay One Savings Card, to:
Pfizer Co-Pay One Savings Card
2250 Perimeter Park Drive, Suite 300
Morrisville, NC 27560

 

For more information or assistance, please contact us.