Terms and Conditions: By using this Co-Pay Program, you
acknowledge that you currently meet the eligibility criteria and will comply with the terms and
conditions described below:
The Pfizer Oncology Together Co-Pay Savings Program for Injectables for
ELREXFIO™ (elranatamab-bcmm), NIVESTYM® (filgrastim-aafi),
NYVEPRIA®
(pegfilgrastim-apgf), RUXIENCE® (rituximab-pvvr),
TRAZIMERA® (trastuzumab-qyyp), and ZIRABEV® (bevacizumab-bvzr), the
Pfizer enCompass Co-Pay Assistance Program for INFLECTRA® (infliximab-dyyb) and
RUXIENCE, and the
ELELYSO® (taliglucerase alfa) Co-Pay Program available through Pfizer Gaucher
Personal Support are not valid for patients who 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”).
Program offer is not valid for cash-paying patients. Patients prescribed RUXIENCE for pemphigus
vulgaris are not eligible for this
co-pay savings program. Patients prescribed ZIRABEV for hepatocellular carcinoma are not eligible
for this co-pay savings program. With this program, eligible patients may pay as little
as $0 co-pay per ELREXFIO, NIVESTYM, NYVEPRIA, RUXIENCE, TRAZIMERA, ZIRABEV, INFLECTRA, or ELELYSO
treatment. There are specific maximum annual patient savings for each
product, which range from $10,000 to $25,000 for out-of-pocket expenses for the respective product
including co-pays or coinsurances. The amount of any benefit is the difference
between your co-pay and $0. After the maximum benefit you will be responsible for the remaining
monthly out-of-pocket costs. Patient must have private insurance with coverage of
ELREXFIO, NIVESTYM, NYVEPRIA, RUXIENCE, TRAZIMERA, ZIRABEV, INFLECTRA, or ELELYSO. This offer is not
valid when the entire cost of your prescription drug is eligible to be reimbursed
by your private insurance plans or other private health or pharmacy benefit programs. You must
deduct the value of this program from any reimbursement request submitted to your
private insurance plan, either directly by you or on your behalf. You are responsible for reporting
use of the program to any private insurer, health plan, or other third party who pays for
or reimburses any part of the prescription filled using the program, as may be required. You should
not use the program if your insurer or health plan prohibits use of manufacturer
co-pay assistance programs. Patient must be 18 years of age or older for redemption of co-pay card
for ELREXFIO, RUXIENCE, TRAZIMERA, or ZIRABEV. This program is not valid where
prohibited by law. This program cannot be combined with any other savings, free trial or similar
offer for the specified prescription.
Co-pay card will be accepted only at participating
pharmacies. This program is not health insurance.
This program is good only in the U.S. and Puerto Rico. This program is limited to 1 per person
during this offering period and is not
transferable. No other purchase is necessary. No membership fee. Data related to your redemption of
the program assistance 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
assistance redemptions and will not identify you. Pfizer reserves the right to rescind, revoke or
amend this program without notice. This program may not be available to patients in all
states. For more information about Pfizer, visit www.pfizer.com. For more information about the
Pfizer Oncology Together Co-Pay Savings Program for Injectables for ELREXFIO,
NIVESTYM, NYVEPRIA, RUXIENCE, TRAZIMERA, or ZIRABEV, visit pfizeroncologytogether.com, call
1-877-744-5675, or write to Pfizer Oncology Together Co-Pay Savings Program for
Injectables, P.O. Box 220366, Charlotte, NC 28222. For more information about the Pfizer enCompass
Co-Pay Assistance Program for INFLECTRA and RUXIENCE for Rheumatoid Arthritis,
call Pfizer enCompass at 1-844-722-6672, or write to Pfizer enCompass Co-Pay Assistance Program,
2730 S. Edmonds Lane, Suite 300, Lewisville, TX 75067. For more information about
the ELELYSO Co-Pay Program available through Pfizer Gaucher Personal Support, call Pfizer Gaucher
Personal Support at 1-855-353-5976, or write to Pfizer Gaucher Personal Support,
2730 S. Edmonds Lane, Suite 300, Lewisville, TX 75067. Program terms and offer will expire at the
end of each calendar year. Before the calendar year ends, you will receive information
and eligibility requirements for continued participation.