Pfizer Factor Savings Card Form

Offers eligible patients savings of up to $12,000 per calendar year that can be used to help cover co-pay, deductible, and coinsurance costs associated with Pfizer factor products.*

 

SAVE ON YOUR FACTOR COSTS*

If you are eligible, you can register for the Pfizer Factor Savings Card. Please answer the following questions to register.

  • Question 1
  • Question 2
  • Registration Form
  • Download Your Card

Terms and conditions apply*

*Pfizer Hemophilia Factor Savings Card Offer Terms and Conditions

OFFER TERMS: By using the Pfizer Factor Savings Card, you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions described below:

The 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 health care 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”). You may receive a total benefit of $12,000 per calendar year, or the amount of your co-pay over one year, whichever is less. 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. You must deduct the value of this offer from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf. The Card is not valid where prohibited by law. The Card cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription. The Card will be accepted only at participating factor suppliers. This Card is not health insurance. Offer good only in the United States and Puerto Rico. The 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. Offer expires 12/31/18. No membership fees. Go to PfizerFactorSavingsCard.com and download your card today.

You can also request a card from your doctor or by calling 1-855-PFZ-HEMO (739-4366).