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Representatives are available:
Monday-Friday 8:00am to 9:00pm Eastern time
Should you have additional questions please contact PfizerPro customer service.
Representatives are available:
Monday-Friday 8:00am to 9:00pm Eastern time
All samples available online to you are included below. Availability is updated periodically.
Savings cards will be shipped with Product Samples, if applicable.
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I certify that I am a licensed prescriber, eligible to request and receive the drug samples listed in the quantities indicated. I am also confirming that these samples will be used exclusively for the medical treatment of my patients in conformity with all relevant state and/or local prescribing and dispensing requirements. My signature will also serve as confirmation of my receipt of these medications, if delivered by a company representative, or my intention to acknowledge them upon delivery to my medical office if shipped via common carrier. I understand that these samples cannot be sold, traded, bartered returned for credit or utilized to seek or obtain reimbursement.
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†Some plans may not display due to health plan-specific policy. The information provided is not a guarantee of coverage of payment (partial or full) and is subject to change without notice.
ST = Step Therapy. Coverage may require Prior Authorization.
†Formulary data provided by Managed Markets Insight & Technology, LLC, (MMIT) are updated monthly and current as of [EFFECTIVE_DATE]. The information provided is not a guarantee of coverage or payment (partial or full) and is subject to change without notice. Please confirm coverage with each patient’s plan. Formulary status does not imply safety or efficacy of any product.
‡The OCTAGAM Co-Pay Program provides eligible patients assistance of up to $12,500 per year. Once a patient reaches the annual maximum benefit, patient is responsible for paying the remaining monthly out-of-pocket costs. The OCTAGAM Co-Pay Program is good only in the US and Puerto Rico. No membership fees. Federal and state health care beneficiaries are not eligible. Private insurance only. Eligibility and restrictions apply. See full Terms and Conditions on the Support and financial assistance page.
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*Some plans may not display due to health plan–specific policy.
The information provided is not a guarantee of coverage of payment (partial or full) and is subject to change without notice.
Patients in your area have access to EUCRISA without restriction or after a trial of one plan-designated topical corticosteroid†
UR – Unrestricted, PA – Prior Authorization, SE – Step Edit/Step Therapy
*Access is defined as no formulary restrictions or trial of one plan-designated topical corticosteroid (TCS).
Not a guarantee of coverage and subject to change. Patients can learn more about their coverage by contacting eucrisa•4•you, their employer, health plan, pharmacy benefits manager(PBM), or retail pharmacy.
†This information relates solely to the formulary status of Eucrisa and is not intended to imply that these products have comparable clincial efficacy or safety profiles or that these products are interchangable. These agents may not have comparable FDA-approved indications.
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May not be a comprehensive list of plans.
Data on file. Pfizer Inc., New York, NY.
†Additional plan limitations may apply relevant to a look back period of time or duration of TCS use.
With the OCTAGAM Co-Pay Program, eligible patients may pay as little as $0‡
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Pfizer for Professionals 1-800-505-4426
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