| Pharmaceutical Company | Pfizer -- Aricept Assistance Program |
| Program Address | ARICEPT Patient Assistance Program 1878 Arena Drive Hamilton NJ 08610 |
| Toll Free Phone Number | 800-226-2072 |
| Alternate Phone Number | n/a |
| Fax Number | 800-226-2059 |
| Guidelines and Notes | Program is different than for other Pfizer drugs. Patients with NO dependents must earn LESS than $25,000 a year. Patients WITH dependents must earn LESS than $40,000 a year. Patient cannot have public or privately funded prescription coverage. Call between 9 am and 9 pm (EST) Monday through Friday. When they send the form, they attach information about other Alzheimer's resources for the patient/caregivers -- both national and local. |
| Initiating Enrollment | Patient, Caregiver, physician's office or physician calls with information. |
| Health Provider's Role | Doctor completes and signs. Prescription is incorporated into the form. Form can be faxed or mailed to them in postage paid envelope provided. |
| Patient's Role | Patient or power of attorney must sign the form, |
| How Dispensed | Sends medicine to doctor's office. |
| Amount Dispensed | 3 month supply |
| Refills | It won't automatically be sent.. |
| Limit | Indefinite |