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Content for financial assistance

If you need assistance with co-pays or paying for your medicine, we are here to find a program that may be able to help—regardless of your insurance coverage.
SELECT AN INSURANCE STATUS

COMMERCIALLY INSURED Resources for eligible commercial, private, employer, and state health insurance marketplace patients

IV CO-PAY ASSISTANCE

If you have commercial insurance, you may be eligible for the Pfizer Oncology Together Co-Pay Program for IV ("IV Co-Pay Program"). Limits, terms, and conditions apply. See below for full Terms and Conditions.

Eligible Commercially Insured Patients* Co-pay may be as little as $0. Once the annual program limit is reached, the patient is responsible for the full co-pay.

$25,000 per Calendar Year Program covers up to $25,000 per calendar year

No Income Requirements There are no income requirements to qualify

To apply, download the Pfizer Oncology Together enrollment form and fill out the required fields and IV Co-Pay Program assistance section. This form requires some information from your healthcare provider, so it’s best to fill it out together.

ENROLLMENT FORM

*For patients to be eligible for the IV Co-Pay Program, they must have commercial insurance that covers BESPONSA, and they cannot be enrolled in a state or federally funded insurance program. Whether a co-pay expense is eligible for the IV Co-Pay Program benefit will be determined at the time the benefit is paid. Co-pay expenses must be in connection with a separately paid claim for BESPONSA administered in the outpatient setting.

The IV Co-Pay Program will pay the co-pay and any deductible obligations for BESPONSA up to the annual assistance limit of $25,000 per calendar year per patient.

IV Co-Pay Program provides assistance for eligible, commercially insured patients for co-pays, co-insurance, or deductibles incurred for BESPONSA, up to $25,000 per calendar year. It does not cover or provide support for supplies, services, procedures, or any other physician-related services associated with BESPONSA treatment.

TERMS & CONDITIONS (FOR PATIENTS)

By enrolling in the Pfizer Oncology Together Co-Pay Program for IV (“IV Co-Pay Program”), you acknowledge that you currently meet the eligibility criteria and will comply with the Terms and Conditions described below:

  1. The IV Co-Pay Program is offered to eligible BESPONSA™ (inotuzumab ozogamicin) (referred to as "Product") patients who are insured through a private/commercial health plan, and are enrolled in the IV Co-Pay Program.
  2. The IV Co-Pay Program does not cover or provide support for supplies, services, procedures, or any other physician-related services associated with Product treatment.
  3. The offer is not valid for medicines that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, Tricare, or other federal or state healthcare 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”).
  4. If your insurance status changes, you must notify us immediately.
  5. The offer is not valid for medicines that are eligible to be reimbursed by private insurance plans or other health or pharmacy benefit programs that reimburse you for the entire cost of your prescription drugs.
  6. You are entitled to maximum assistance of $25,000 per calendar year per patient.
  7. The IV Co-Pay Program will pay your co-pay and any deductible obligations for Product up to the annual assistance limit of $25,000 per calendar year per patient. You remain responsible for paying all co-pays and any balance not covered by the Program.
  8. Whether a co-pay expense is eligible for the IV Co-Pay Program benefit will be determined at the time the benefit is paid. Co-pay expenses must be in connection with a separately paid claim for Product administered in the outpatient setting.
  9. You must deduct the value received under the IV Co-Pay Program from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf.
  10. Cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified medicine.
  11. Offer is limited to 1 per person during this offering period and is not transferable.
  12. The IV Co-Pay Program offer is good only in the United States and Puerto Rico.
  13. Pfizer reserves the right to rescind, revoke, or amend this offer without notice.
  14. No membership fees. This offer is not health insurance.
  15. Claims must be submitted to the IV Co-Pay Program within 120 days of the date of the Explanation of Benefits (EOB) from your primary insurance company.
  16. Offer expires 12/31/2019.
  17. The IV Co-Pay Program is not valid where prohibited by law.

For more information about the Pfizer Oncology Together Co-Pay Program for IV, call 1-877-744-5675 or write Pfizer Oncology Together Co-Pay Program for IV, P.O. Box 220366, Charlotte, NC 28222-0366.

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MEDICARE/GOVERNMENT INSURED Help identifying resources for patients with Medicare, Medicaid, and other government insurance plans

Support from independent charitable foundations

Pfizer Oncology Together will assist patients with searching for financial support that may be available from independent charitable foundations. These foundations exist independently of Pfizer and have their own eligibility criteria and application processes. Availability of support from the foundations is determined solely by the foundations.

Free MEDICINE

If independent charitable foundation support is not available, Pfizer Oncology Together will provide eligible patients with BESPONSA for free through the Pfizer Patient Assistance Program.§

§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.

To get started:
For live support, call 1-877-744-5675
(Monday–Friday 8 am–8 pm ET)

 

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UNINSURED Help identifying resources for patients who do not have any form of healthcare coverage

help finding COVERAGE

Pfizer Oncology Together will check if you are eligible for a government program that helps pay for prescription medication through Medicaid or Medicare. If you are eligible, we will guide you on how to apply and provide assistance throughout the entire process.

Free MEDICINE or Savings

If you do not have insurance or prescription coverage and you are unable to afford your medication, we may be able to help. Pfizer Oncology Together can provide you with BESPONSA for free or at a savings, if you are eligible, through the Pfizer Patient Assistance Program.

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.

To get started:
For live support, call 1-877-744-5675
(Monday–Friday 8 am–8 pm ET)

 

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REMEMBER, COMPLETE ALL ENROLLMENT FORMS WITH YOUR HEALTHCARE TEAM

Bepsonsa patient in content isi

Important Safety Information and Indication for BESPONSA (inotuzumab ozogamicin)

WARNING: RISK OF LIVER PROBLEMS AND INCREASED RISK OF DEATH AFTER STEM CELL TRANSPLANT

BESPONSA can cause liver problems that can be severe, life-threatening, or lead to death, including a condition called veno-occlusive disease (VOD). This condition can occur during treatment with BESPONSA or following subsequent treatment with a stem cell transplant. Patients who have previously received a stem cell transplant and patients with a history of liver problems, including VOD, may be at an increased risk of VOD.

BESPONSA may cause serious side effects, including:

  • Liver problems: Call your doctor right away if you experience rapid weight gain, yellowing of the whites of the eyes, or abdominal swelling that may be painful. The risk of developing VOD is increased after receiving treatment with BESPONSA. Discuss with your doctor the benefit/risk of BESPONSA treatment if you have a prior history of VOD or serious ongoing liver disease
  • Increased risk of death after stem cell transplant: Call your doctor right away if you experience any signs and symptoms of infection or liver problems. There is an increased risk of death due to infection and VOD after receiving BESPONSA
  • Low blood cell counts: Call your doctor right away if you experience signs and symptoms of infection (for example, redness, swelling), unexpected bleeding or bruising, blood in your urine or stools, or fever. BESPONSA may cause low platelet counts (thrombocytopenia), low red blood cell counts (anemia), and low white blood cell counts (neutropenia)
  • Infusion-related reactions: Inform your doctor right away if you experience fever, chills, rash, or breathing problems during or following your BESPONSA infusion
  • Heart problems: Call your doctor right away if you feel dizzy, lightheaded, or faint or have very slow, very fast, or abnormal heartbeats. Tell your doctor if you take any heart or blood pressure medicines

Before taking BESPONSA, tell your doctor about all of your medical conditions, including if you:

  • Have liver disease or a history of liver problems
  • Have an infection
  • Have ever experienced symptoms such as fever, chills, rash, or breathing problems during or shortly after your BESPONSA infusion
  • Have heart problems, including an event of QT prolongation
  • Are pregnant, plan to become pregnant, or if pregnancy is suspected while taking BESPONSA. Avoid becoming pregnant during treatment with BESPONSA. BESPONSA can cause harm to an unborn baby
    • o Females who are able to become pregnant should use effective contraception during treatment with BESPONSA and for at least 8 months after the last dose
    • o Males of reproductive potential should use effective contraception during treatment with BESPONSA and for at least 5 months after the last dose
  • Are breastfeeding or plan to breastfeed. Avoid breastfeeding during treatment with BESPONSA and for at least 2 months after the final dose

Common Side Effects of BESPONSA

The most common side effects are low platelet counts (thrombocytopenia), low white blood cell counts (neutropenia and leukopenia), infection, low red blood cells counts (anemia), fatigue, bleeding, fever, nausea, headache, increases in lab tests measuring liver function, and pain in the abdomen.

These are not all of the possible side effects of BESPONSA. Tell your doctor if you have any side effect that bothers you or that does not go away. For more information, ask your doctor or pharmacist.

Indication

BESPONSA is a prescription medicine used to treat adults with relapsed or refractory B-cell acute lymphoblastic leukemia (ALL). It is not known if BESPONSA is safe and effective in children under 18 years of age.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Please see full Prescribing Information, including BOXED WARNING for BESPONSA (inotuzumab ozogamicin).

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Besponsa Patient - Important Safety Information and Indication

Important Safety Information and Indication for BESPONSA (inotuzumab ozogamicin)

WARNING: RISK OF LIVER PROBLEMS AND INCREASED RISK OF DEATH AFTER STEM CELL TRANSPLANT

BESPONSA can cause liver problems that can be severe, life-threatening, or lead to death, including a condition called veno-occlusive disease (VOD). This condition can occur during treatment with BESPONSA or following subsequent treatment with a stem cell transplant. Patients who have previously received a stem cell transplant and patients with a history of liver problems, including VOD, may be at an increased risk of VOD.

BESPONSA may cause serious side effects, including:

  • Liver problems: Call your doctor right away if you experience rapid weight gain, yellowing of the whites of the eyes, or abdominal swelling that may be painful. The risk of developing VOD is increased after receiving treatment with BESPONSA. Discuss with your doctor the benefit/risk of BESPONSA treatment if you have a prior history of VOD or serious ongoing liver disease
  • Increased risk of death after stem cell transplant: Call your doctor right away if you experience any signs and symptoms of infection or liver problems. There is an increased risk of death due to infection and VOD after receiving BESPONSA
  • Low blood cell counts: Call your doctor right away if you experience signs and symptoms of infection (for example, redness, swelling), unexpected bleeding or bruising, blood in your urine or stools, or fever. BESPONSA may cause low platelet counts (thrombocytopenia), low red blood cell counts (anemia), and low white blood cell counts (neutropenia)
  • Infusion-related reactions: Inform your doctor right away if you experience fever, chills, rash, or breathing problems during or following your BESPONSA infusion
  • Heart problems: Call your doctor right away if you feel dizzy, lightheaded, or faint or have very slow, very fast, or abnormal heartbeats. Tell your doctor if you take any heart or blood pressure medicines

Before taking BESPONSA, tell your doctor about all of your medical conditions, including if you:

  • Have liver disease or a history of liver problems
  • Have an infection
  • Have ever experienced symptoms such as fever, chills, rash, or breathing problems during or shortly after your BESPONSA infusion
  • Have heart problems, including an event of QT prolongation
  • Are pregnant, plan to become pregnant, or if pregnancy is suspected while taking BESPONSA. Avoid becoming pregnant during treatment with BESPONSA. BESPONSA can cause harm to an unborn baby
    • o Females who are able to become pregnant should use effective contraception during treatment with BESPONSA and for at least 8 months after the last dose
    • o Males of reproductive potential should use effective contraception during treatment with BESPONSA and for at least 5 months after the last dose
  • Are breastfeeding or plan to breastfeed. Avoid breastfeeding during treatment with BESPONSA and for at least 2 months after the final dose

Common Side Effects of BESPONSA

The most common side effects are low platelet counts (thrombocytopenia), low white blood cell counts (neutropenia and leukopenia), infection, low red blood cells counts (anemia), fatigue, bleeding, fever, nausea, headache, increases in lab tests measuring liver function, and pain in the abdomen.

These are not all of the possible side effects of BESPONSA. Tell your doctor if you have any side effect that bothers you or that does not go away. For more information, ask your doctor or pharmacist.

Indication

BESPONSA is a prescription medicine used to treat adults with relapsed or refractory B-cell acute lymphoblastic leukemia (ALL). It is not known if BESPONSA is safe and effective in children under 18 years of age.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Please see full Prescribing Information, including BOXED WARNING for BESPONSA (inotuzumab ozogamicin).