| Pharmaceutical Company | Pfizer, Inc. |
| Program Address | Pfizer Connection to Care PO BOx 66585 St. Louis MO 63166-6585 |
| Toll Free Phone Number | 800-707-8990 |
| Fax Number | n/a |
| Guidelines and Notes | Call between 8:30 am to 5:30 pm Eastern Time, M-F. Single patient income cut-off is $16,000 or less; $25,000 or less for a family. Patient must be indigent and not eligible for any kind of public or private prescription coverage. Physician or patient can follow up on status of request once the request has been made but company will inform physician of status by mail. Program covers products that are for chronic use. See separate entries for Diflucan and Zithromax and for Aricept. |
| Initiating Enrollment | Physician should call for an application to be faxed . Physician section of the application is brief. Signature required, and original prescription must be attached. |
| Health Provider's Role | Completed application and income documentation must be sent in with original prescription. |
| Patient's Role | Complete patient section, sign and attach proof of income. This will either be a tax return or a 4506 form to get verification that taxes weren't filed. Also attach a copy of the Social Security award letter if no taxes are filed, |
| How Dispensed | Sends medicine to doctor -- provide street address, NOT PO BOX!! |
| Amount Dispensed | Three month supply, usually sent 3 to 4 weeks after receipt of the request.. Physician is sent a letter eligibility status of patient. |
| Refills | After a year they'll have to resubmit proof of income along with new application. |
| Limit | Indefinite |