Pfizer, 500
tablet , red , oval oblong
Debossed
Pl visit www.bosulif.com for more info.from Pfizer
Filling your prescription for BOSULIF and assistance program
Getting access to BOSULIF
BOSULIF? (bosutinib) is available only by prescription through retail and specialty pharmacies. Specialty pharmacies offer a range of services, including mail order, to help with access and are able to coordinate delivery of BOSULIF regardless of where you live. If you need help determining which specialty pharmacy to use, your doctor?s office may be able to help you find one that works with your insurance.
You or your doctor?s office can also call Pfizer First Resource? at 1-877-744-5675 . One of its Patient Care Coordinators should be able to help you or your doctor?s office identify an appropriate specialty pharmacy. First Resource will ask you a few basic questions, including your insurance information, in order to identify an appropriate specialty pharmacy.
Pfizer is committed to helping people get the Pfizer medicines they need.
Your co-pay could be covered*
How does it work?
If you are eligible, the BOSULIF Co-pay Program can help lower your out-of-pocket costs for BOSULIF. If eligible, you will receive 80% off your monthly out-of-pocket costs or pay no more than $50 for each 30-day prescription of BOSULIF?whichever benefits you more?with an annual benefit maximum of $24,000.
What does this mean for you?
If your out-of-pocket costs for your prescription for BOSULIF are less than $250, you will receive 80% off
If your out-of-pocket costs for your prescription for BOSULIF are more than $250, you will pay $50
For example:
Are you eligible?
Respond to the following statements to see if you may be eligible for the BOSULIF Co-pay Program:
If you answered ?yes? to all of the above statements, you may be eligible.
How to enroll
Patients can apply for the co-pay card by calling 1-855-4-BOSULIF ( 1-855-426-7854 ) 24 hours a day Monday-Friday, Saturday 8 AM?7 PM (EST), and Sunday 9 AM?5 PM (EST).
Are you uninsured or do not have enough coverage?
If you are uninsured or do not have enough prescription drug coverage, you may be able to get your prescription for BOSULIF for free through the Pfizer First Resource program. A program counselor can help research and find what programs you may be eligible for to get BOSULIF.
Call 1-877-744-5675 , Monday?Friday 9 AM?8 PM (EST) to learn more.
*For eligible patients only. The BOSULIF Co-pay Program is not health insurance.
There are no membership fees to participate.
Terms and Conditions for Co-pay Program
By enrolling in the co-pay offer for BOSULIF, you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions described below:
1.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 (including any state prescription drug assistance programs and the Government Health Insurance Plan available in Puerto Rico [formerly known as ?La Reforma de Salud?]).
2.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 you for the entire cost of your prescription drugs.
3.Maximum benefit per claim: $8,000 per 30-day prescription.
4.Maximum annual savings of $24,000.
5.You must deduct the value received under this program from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf.
6.Cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription.
7.The offer will be accepted only at participating pharmacies.
8.This offer is not health insurance.
9.Offer good only in the United States and Puerto Rico.
10.Pfizer reserves the right to rescind, revoke, or amend the program without notice.
11.Program expires 12/31/2013.
12.No membership fees.
13.The offer is limited to 1 per person during this offering period and is not transferable.
