Recently, Pfizer implemented changes to the Pfizer Patient Assistance Program (PAP)*:
For 2025, Pfizer is implementing new PAP requirements for Medicare Part D/Medicare Advantage patients, as more options have become available to help patients afford their medicines, including the Inflation Reduction Act.
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 voluntary Medicare Prescription Payment Plan*** (MPPP) prior to requesting assistance from the PAP AND
‒ NEW & EFFECTIVE IMMEDIATELY: Submit proof of their enrollment in MPPP with their PAP enrollment form. Patients may receive a "Notice of Acceptance of Election" form from their Med D plan that confirms they are enrolled in the MPPP. Missing proof of enrollment in MPPP will prevent the enrollment form from being processed for patients with annual pre-tax household income above 138% FPL. Patients who have already submitted their enrollment form for 2025 will be subject to this new requirement.
‒ 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/Medicare Advantage 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).
‒ NEW & EFFECTIVE IMMEDIATELY: Additionally, before being considered for the PAP, patients will be required to apply to all open, applicable and relevant, diagnosis-specific Independent Charitable Patient Assistance Programs (ICPAPs) as provided by the Pfizer Program. If declined support from ICPAP(s), patients must continue to submit written proof of their denial for each fund. Patients who have submitted their application for 2025 will be subject to this new requirement.
Finally, to be eligible for the PAP in 2025, Medicare Part D/Medicare Advantage 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 Part D/Medicare Advantage, Medicaid, Champus/TRICARE & VA. Commercially insured patients are not eligible.
‒ Work with their healthcare provider’s office, pharmacy, and/or health plan to understand their monthly and total prescription costs for the year which they are requesting assistance AFTER:
i. Prior authorization is obtained by their healthcare provider (if required by their insurer) AND
ii. Enrolling in the voluntary Medicare Prescription Payment Plan (for Medicare Part D/Medicare Advantage Patients only).
‒ 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.
- Pfizer remains committed to serving the evolving needs of patients as they navigate all available pathways to help them access their medicines. We understand that these changes may affect some of our patients and are working to ensure a smooth transition.
- 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).
- 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.
- 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.
- 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.
General FAQs
Why is Pfizer adding this new requirement for patients enrolled in a Medicare Part D/Medicare Advantage Plan in 2025?
The 2025 benefit changes outlined in the Inflation Reduction Act will help many Medicare Part D/Medicare Advantage patients, including (1) the reduction of out-of-pocket prescription costs for covered medicines to $2,000 annually and (2) a voluntary option for enrollment in the Medicare Prescription Payment Plan.
NEW & EFFECTIVE IMMEDIATELY: When is the new Certification and demonstration of MPPP enrollment and/or ICPAP denial required for Medicare Part D/Medicare Advantage patients?
All Medicare Part D/Medicare Advantage enrollees seeking access to the Pfizer Patient Assistance Program for the 2025 enrollment year, must attest to and provide evidence of their enrollment in the Medicare Prescription Payment Plan. In addition, patients must apply to all applicable ICPAPs and continue to provide proof of ICPAP denial, from each before being considered for PAP. These requirements will immediately be applied to all 2025 enrollment form submissions.
To demonstrate proof of MPPP enrollment, patients can provide a paper letter or email confirmation, or screen shot of enrollment. Missing proof of enrollment in MPPP will prevent the enrollment form from being processed for patients with an annual pre-tax household income above 138% of the FPL.
To demonstrate proof of denial from all ICPAPs to which a patient was referred, patients should include a paper or email notification, or screen shot of the denial from the ICPAP(s) indicating their denial for support. In certain circumstances, if the ICPAP does not provide written documentation, we will accept a patient’s verbal confirmation that they were denied along with the reason for denial. Applications will not be processed until/unless the documentation is received.
NEW: Why is Pfizer requesting proof of MPPP enrollment and/or proof of denial from all applicable ICPAPs?
Pfizer’s PAP is a last resort, safety net program, for patients with the most financial need. As such, we encourage patients to explore all of their options, and if the patient’s prescription costs remain unaffordable after this, only then should patients consider applying for the PAP.
When and how can patients enroll in the voluntary Medicare Prescription Payment Plan?
Medicare beneficiaries have the option to enroll in the Medicare Prescription Payment Plan during the Medicare Part D/Medicare Advantage Open Enrollment Period (which began on October 15th, 2024), as well as at any time during the plan year. For more information on the Medicare Prescription Payment Plan and how to enroll, patients can call their health plan, visit their plan’s website, and/or visit: https://www.medicare.gov/prescription-payment-plan.
The patient’s healthcare provider, specialty pharmacy, alternative funding resource, or others are telling the patient not to enroll in the Medicare Prescription Payment Plan. What should the patient do?
The decision to enroll in the Medicare Prescription Payment Plan is voluntary and completely up to the patient. If the patient chooses not to enroll in the Medicare Prescription Payment Plan, they will not be eligible for enrollment/re-enrollment in the Pfizer Patient Assistance Program. We encourage the patient to discuss this with their healthcare provider.
When are these changes effective?
All changes are effective January 1, 2025. Patients who have already submitted their application in 2024 and are awaiting their PAP determination for 2025 will be informed if they need to take additional action such as providing proof/documentation of MPPP enrollment and/or ICPAP denials.
Pfizer made changes to the program in 2023 and 2024. Why is Pfizer making changes to the PAP again, in 2025?
Periodically, Pfizer reviews the PAP to confirm it is supporting the evolving needs of patients in a rapidly changing healthcare environment. These changes are a response to the Inflation Reduction Act which caps Medicare Part D/Medicare Advantage patients’ annual out of pocket prescription drug costs for covered medicines at $2,000 and enables patients to have the option to enroll in the Medicare Prescription Payment Plan to spread out their monthly medicine costs.
Will Pfizer continue to make these changes in future years?
Pfizer may adjust the PAP in coming years in accordance with changes in the healthcare landscape, including but not limited to, new policies and regulations that impact patients’ ability to afford their Pfizer medicine and vaccines.**
Are there other resources which can help patients get access to medicines if they don’t qualify for the Pfizer PAP?
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. Other resources may be of help (depending on the medicine or vaccines) such as NeedyMeds, RxOutreach (among others), commercial co-pay cards (restrictions apply), and local pharmacy savings programs.
What are the appropriate contacts for questions about these program changes?
Patients & Healthcare Providers – Please contact 1-844-989-PATH (7284)
What are the income eligibility criteria for the Pfizer PAP?
The income eligibility criteria for all patients applying to the PAP for assistance with any product other than a vaccine remains at an annual pre-tax household income at or below 300% Federal Poverty Level (FPL) adjusted for household size. (Federal Poverty Level Guidelines available at https://aspe.hhs.gov/poverty-guidelines). Effective January 1, 2025, the FPL limit for all products, including vaccines will be 300% of the FPL. Though the FPL Guidelines are subject to change in January of each year, currently 300% of the FPL in the 48 contiguous states excluding Alaska and Hawaii is:
| Persons in family/household | Poverty guideline | 300% of the FPL |
|---|---|---|
| 1 | $15,060 | $45,180 |
| 2 | $20,440 | $61,320 |
| 3 | $25,820 | $77,460 |
| 4 | $31,200 | $93,600 |
| 5 | $36,580 | $109,740 |
| 6 | $41,960 | $125,880 |
| 7 | $47,340 | $142,020 |
| 8 | $52,720 | $158,160 |
Are uninsured patients who meet the income eligibility criteria eligible for the PAP?
Yes. Patients without an insurance plan who meet the income eligibility criteria may be eligible for the PAP if all other PAP eligibility criteria are met.
Do patients who have public insurance and meet the income eligibility criteria qualify for PAP?
Yes. Patients who have public insurance, meet the income eligibility criteria, and have a valid, on- label prescription from their healthcare provider may be eligible for the PAP, assuming all criteria have been met for the program. Public Insurance includes, but is not limited to Medicare Part D/Medicare Advantage, Medicaid, Champus/TRICARE & VA.
Do patients who have commercial insurance and meet the income eligibility criteria qualify for PAP?
No, commercially- insured patients are not eligible for the Pfizer PAP.
Are currently enrolled PAP patients eligible to apply for re-enrollment?
Yes, patients currently enrolled in the PAP may be eligible for re-enrollment in the PAP program in 2025 if their annual pre-tax household income is at or below 300% of the Federal Poverty Level (FPL) and they meet all other 2025 eligibility requirements.
What products will remain within Pfizer PAP as of January 1, 2025?
| Type | Primary Care | Specialty Care | Oncology |
|---|---|---|---|
| Medicines |
|
|
|
| Vaccines |
|
NOTE: This list of products is subject to change
What products will remain within Pfizer PAP as of January 1, 2024?
| Type | Primary Care | Specialty Care | Oncology |
|---|---|---|---|
| Medicines |
|
|
|
| Vaccines |
|
* The Pfizer Patient Assistance Program is a joint program of Pfizer Inc. and the Pfizer Patient Assistance Foundation™. The Pfizer Patient Assistance Foundation is a separate legal entity from Pfizer Inc., with distinct legal restrictions.
** NOTE: Pfizer reserves the right to modify, amend, or revise the program terms and conditions in its sole discretion at any time.
*** The Pfizer Patient Assistance Program requires prior enrollment in the voluntary Medicare Prescription Payment Plan for applicable products covered and reimbursed by Medicare Part D/Medicare Advantage Plans. Contact your prescription health insurance plan to learn more.
View our other resources
Need further assistance?
Contact us at 1-844-989-PATH (7284) for New Patients.
Contact us at 1-866-706-2400 for Enrolled PAP Patients.