Terms and Conditions
By enrolling the patient in this co-pay offer, you acknowledge that the patient currently meets the eligibility criteria and will comply with the Terms and Conditions described below:
- The offer is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, or other federal or state healthcare programs (such as any state prescription drug assistance programs and the Government Health Insurance Plan available in Puerto Rico [formerly known as “La Reforma de Salud”]).
- The offer is not valid for prescriptions that are eligible to be reimbursed by private insurance plans or other health or pharmacy benefit programs, which reimburse your patient for the entire cost of his or her prescription drugs.
- The patient is responsible for $10 or the full amount of his or her co-pay, whichever is less, for each monthly prescription of a covered medicine. The amount of any savings is the difference between the patient’s co-pay and $10. The patient is entitled to maximum savings of $25,000 per calendar year per patient.
- The patient must deduct the value received under this program from any reimbursement request submitted to his or her insurance plan.
- Cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription.
- The offer will be accepted only at participating pharmacies.
- This offer is not health insurance.
- Offer good only in the United States and its territories.
- Pfizer reserves the right to rescind, revoke, or amend the program without notice.
- Program expires 12/31/2017.
- No membership fees.
- The offer is limited to 1 per person during this offering period and is not transferable.
- For reimbursement when using a nonparticipating pharmacy: Mail a copy of the patient’s pharmacy receipt indicating patient name, name of medication purchased, price paid, and date purchased, along with a copy of the patient’s Pfizer Co-Pay One Savings Card, to:
Pfizer Co-Pay One Savings Card
2250 Perimeter Park Drive, Suite 300
Morrisville, NC 27560