Pfizer RxPathways Updates

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

The program changes will be implemented January 1, 2025, and are as follows: 

2025 PAP Changes

A.  Effective January 1, 2025, the new PAP program requirements for Medicare Part D patients who are requesting assistance with a Pfizer product covered under their plan are:

• Patients must enroll in the Medicare Prescription Payment Plan prior to requesting assistance AND

• On their enrollment form, patients must attest to:

  - Enrollment in the Medicare Prescription Payment Plan,

  - Knowing their monthly co-payment and annual out-of-pocket maximum for covered medicines which will be $2,000 for most Medicare Part D patients, Inability to afford their co-payment, AND​

  - Not yet reaching their annual out-of-pocket maximum (after which they would have a $0 co-payment for covered medicines).

   

• Additionally, to be eligible for the PAP in 2025, Medicare Part D patients must also:

  - Meet the annual pre-tax household income eligibility requirement of at or below 300% of the Federal Poverty Level (FPL).

     i. For applicable programs/products: The grace period for patients currently enrolled with an annual pre-tax household income between 301-500% of the FPL ends on December 31, 2024.

  - Have a valid prescription for a Pfizer medicine available in the PAP.

  - Have a valid prescription for an FDA-approved indication for the requested medicine(s) or vaccine(s).

  - Be uninsured or publicly insured via government-provided insurance and unable to afford their copayment. Public Insurance includes, but is not limited to Medicare, Medicaid, Champus/TRICARE & VA. Commercially insured patients are not eligible.

  - Reside in the U.S. or a U.S. covered territory (U.S. covered territories include U.S. Virgin Islands, Guam and Puerto Rico)

  - Be treated by a healthcare provider licensed in the U.S. or a covered U.S. territory (U.S. covered territories include U.S. Virgin Islands, Guam and Puerto Rico)

   

• Patients enrolled in the PAP and who may be affected by these changes for 2025 can continue their enrollment in the program until their end date if they continue to meet eligibility criteria.

B.  Effective January 1, 2025, patients who received a grace period in 2024 must meet all of the 2025 PAP eligibility requirements to continue receiving product through the PAP.

• Previously enrolled PAP Patients affected by 2024 changes to the eligibility criteria —namely, patients who were above income eligibility with an annual pre-tax household income between 301-500% of the Federal Poverty Level (FPL) —who were allowed to remain in the program to allow them time to find alternative options for 2025 must now meet all 2025 eligibility requirements in order to re-enroll.
• In addition to the PAP, Pfizer will continue to provide other assistance programs that offer patients information regarding if/how their insurance may cover their prescriptions, co-pay support, and information about independent third-party assistance options via Pfizer RxPathways and other patient support programs. Eligibility for services may vary based on specific medicines and conditions. 
• We encourage patients to consult with their healthcare provider and/or insurance provider to explore the options that best address their healthcare and financial needs. There are other resources that may be able to help, depending on the medicine or vaccine, such as NeedyMeds, RxOutreach (among others), commercial co-pay cards (restrictions apply) and local pharmacy savings programs.

2024 PAP Changes

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

The program changes will be implemented January 1, 2024, and are as follows: 

1.  The income eligibility requirement for all products within the PAP will be 300% of the Federal Poverty Level (FPL), adjusted for household size (HH) (100% of the FPL for vaccines).

1. All new patients applying to the PAP for 2024 enrollment must meet the new income eligibility requirement of at or below 300% of the FPL (100% of the FPL for vaccines), adjusted for HH size. Complete 2024 eligibility requirements are listed below.
2. Patients who are currently enrolled in the PAP with income at an FPL above 300% up to 500%, adjusted for HH size, may apply for re-enrollment and be eligible to continue receiving their medicine in 2024 if they meet all other 2024 eligibility requirements listed below.

2.  As of January 1, 2024, any 2023 PAP grace period recipients must meet 2024 PAP requirements.

1. Full eligibility requirements for enrollment in PAP as of January 1, 2024, are detailed below.

*As a result of the 2023 changes to the PAP, Pfizer granted a grace period for affected patients. The term grace period will be used in place of the term grandfathered.

To be eligible for the PAP in 2024, patients must:

• Have a valid prescription for a Pfizer medicine available in the PAP  
• This prescription must be for an FDA-approved indication for the requested medicine(s) or vaccine(s)
• Be uninsured or publicly insured via government-provided insurance and unable to afford their copayment. Public Insurance includes Medicare, Medicaid, Champus/TRICARE & VA. Commercially insured patients are not eligible.
• Meet income guidelines at or below 300% of the Federal Poverty Level, adjusted for household size 
• For vaccines, meet income guidelines at or below 100% of the Federal Poverty Level, adjusted for household size
• Reside in the U.S. or a U.S. covered territory (U.S. covered territories include U.S. Virgin Islands, Guam and Puerto Rico)
• Be treated by a healthcare provider licensed in the U.S. or a covered U.S. territory (U.S. covered territories include U.S. Virgin Islands, Guam and Puerto Rico)

We recognize that these program changes may be significant for certain patients.

• During the transition, some patients who are currently enrolled in the PAP and affected by these changes for 2024 may be able to continue their enrollment in the program, depending on eligibility requirements. See below for more information.
• In addition to the PAP, Pfizer will continue to provide other assistance programs that offer patients information regarding if/how their insurance may cover their prescriptions, co-pay support, and information about independent third-party assistance options via Pfizer RxPathways and other patient support programs. Eligibility services may vary based on specific medicines and conditions.  
• We encourage patients to consult with their healthcare provider and/or insurance provider to explore the options that best address their healthcare and financial needs. There are other resources that may be able to help, depending on the medicine or vaccine, such as NeedyMeds, RxOutreach (among others), commercial co-pay cards (restrictions apply) and local pharmacy savings programs.