Pfizer RxPathways Updates

Recently, Pfizer implemented changes to the Pfizer Patient Assistance Program (PAP)*:

Starting January 1, 2023, patients applying for the PAP must meet income guidelines to be eligible for assistance.

• All new patients applying to the PAP for primary care products must meet the new income eligibility requirement of 300% FPL.
• All new patients applying to the PAP must meet income eligibility requirements -- 300% FPL for Primary Care products and 500% or 600% FPL for Specialty and Oncology products.

Patients applying for the PAP must meet income guidelines to be eligible for assistance. There will be no income exception process.

• Patients enrolled in the PAP via the income level exception process on or prior to September 30, 2022, may continue enrollment in the program if their income does not exceed the annual household income they were approved with in 2022.
• They will be required to reenroll at the appropriate time.
• Patients applying for assistance on or after October 1, 2022, with income greater than the income criteria will be denied enrollment.

Effective January 1, 2023, commercially insured patients are not eligible for the PAP, regardless of their income status or medicine’s formulary status.

Commercially insured patients (e.g., patients who get their insurance through their job or through a Federal Employer Plan) who are currently receiving their medicine(s) through the PAP may continue enrollment in the program if:

• they meet income and other eligibility requirements,
• their medicine is available through the program, and
• they have a valid on-label prescription from their healthcare provider.
• Patients will be required to reenroll at the appropriate time.

Starting January 1, 2023, the PAP will no longer include certain off-patent products because alternative and/or generic products are available for the FDA approved indications they treat.

• Please see the list of medicines (below) available through the PAP in 2023.

Starting January 1, 2023, medicines accessed through the PAP must be for an FDA approved indication.

• Patients who are currently receiving their medicine(s) for an off-label indication through the PAP may continue enrollment in the program if they meet the established income and other eligibility requirements and have a valid prescription from their healthcare provider. Patients will be required to reenroll at the appropriate time.

We recognize that these program changes may be significant and will affect patients. During the transition, some patients who are currently enrolled in the PAP and affected by these changes may be able to continue their enrollment in the program.

There are also other resources that may be able to help such as NeedyMeds, RxOutreach (among others), brand co-pay cards (restrictions apply) and local pharmacy savings programs. Patients should speak to their healthcare provider for options that might be right for them.