TO BE EVALUATED FOR ASSISTANCE, PATIENTS AND THEIR HEALTHCARE PROVIDERS MUST SUBMIT A COMPLETED ENROLLMENT FORM. PATIENTS MUST ALSO PROVIDE PROOF OF INCOME, SUCH AS A W2 FORM, A PAYCHECK STUB, OR PRIOR YEAR'S TAX RETURN. IN SOME CASES, PATIENTS PRESCRIBED CERTAIN PFIZER MEDICINES MAY FIRST BE REQUIRED TO SEEK ALTERNATE FORMS OF ASSISTANCE BEFORE THEY CAN BE CONSIDERED FOR FREE MEDICINE THROUGH THE PFIZER PATIENT ASSISTANCE PROGRAM.

TO QUALIFY, PATIENTS MUST HAVE A VALID PRESCRIPTION FOR THE PFIZER MEDICINE, AVAILABLE IN THE PAP, FOR WHICH THEY ARE SEEKING ASSISTANCE; HAVE AN FDA-APPROVED INDICATION FOR THE REQUESTED PRODUCT(S); BE UNINSURED OR GOVERNMENT INSURED AND UNABLE TO AFFORD THEIR COPAYMENT; MEET INCOME GUIDELINES, WHICH VARY BY MEDICINE, BUT START AT 300% OF THE FEDERAL POVERTY LEVEL, ADJUSTED FOR FAMILY SIZE; RESIDE IN THE U.S. OR A U.S. TERRITORY; AND BE TREATED BY A HEALTHCARE PROVIDER LICENSED IN THE U.S. OR A U.S. TERRITORY. COMMERCIALLY INSURED PATIENTS ARE NOT ELIGIBLE.