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Applications

Connection to Care® Connection to Care provides Pfizer medicines for free to qualified patients through their doctors' offices.*

For new patient applications (general application)
Download New Patient Application in English
Download New Patient Application in Spanish
Download authorization form
Patients should also sign the authorization form above and give it to their doctors. It allows their doctors to share certain patient information with Pfizer in connection with the program. This form should not be returned with a patient's application.

For new patients
If you are a healthcare provider and want to expedite the delivery of your patients' first supply of the Pfizer medicines listed below, please call 1-866-706-2400.

• Geodon^® (ziprasidone HCI)
• Inspra^® (eplerenone)
• Tikosyn^® (dofetilide)(registered prescribers only)
• Zithromax^® (azithromycin)

For patients with hardship
While many Pfizer patient assistance programs are designed to help people without prescription coverage, Pfizer understands that some lower income people with prescription coverage may have difficulty paying for their Pfizer medicines if they are experiencing a hardship.

If you have prescription drug coverage but are faced with significant financial hardship, you may qualify for a Hardship Exception through Connection to Care. You can complete the Patient Hardship Exception section on the Patient Application Form.

For additional information call us at 1-866-706-2400.

For enrolled patients
Download Enrolled Patient Order Form in English (to reorder medicines)

Pfizer Pfriends® Pfizer Pfriends provides savings on 88 Pfizer medicines at participating pharmacies  in the United States, including Puerto Rico and the US Virgin Islands. The program helps qualified patients without prescription coverage, regardless of age or income.

Download English version
Download Spanish version

Pfizer MAINTAIN™ Program The Pfizer MAINTAIN Program (Medicines Assistance for Those who Are In Need) provides free Pfizer medicines to qualified patients, delivered right to their home. This newly created program can help eligible patients who have recently become unemployed and are currently uninsured continue receiving their Pfizer medicines. Applications for enrollment into the Pfizer MAINTAIN Program will be accepted through December 31, 2010. Program participants will receive their Pfizer medicines for free for up to one year, or until they become insured, whichever comes first.

Download English version
Download Spanish version

Pfizer Helpful Answers—RSVP® RSVP offers reimbursement support and patient assistance to help patients get access to Pfizer medicines, including Zyvox® (linezolid), Vfend® (voriconazole), and Revatio ®(sildenafil citrate).

Download English version
Download Spanish version

First Resource® First Resource offers reimbursement support, free medicines, and co-pay assistance to help patients get access to specific Pfizer medicines, including Sutent®(sunitinibmalate) capsules and Aromasin®(exemestane tablets)

Download English version
Download English SUTENT Application
Download Spanish version
Download Spanish Sutent Application

*Home delivery in Puerto Rico and US Virgin Islands.