Support and resources

• Pfizer IGuide™ can help identify financial assistance resources for which you may be eligible to help with out-of-pocket costs for OCTAGAM

• If you have commercial, employer, or private coverage, including coverage purchased through a state health insurance marketplace, you may be eligible for the OCTAGAM Co-Pay Program, which can help cover the cost of your co-pay. Eligible patients may pay as little as $0 per OCTAGAM treatment. The value of the co-pay card is limited to a maximum of $12,500 per calendar year. See terms and conditions below

• If you have government-funded insurance and need help to cover the cost of OCTAGAM, Pfizer IGuide™ can help identify financial support options including alternate coverage resources, if available

• If you do not have health insurance and cannot afford your OCTAGAM treatment, Pfizer IGuide™ can connect you to potential resources that may help cover the cost of OCTAGAM, including how to apply to Medicaid if you may be eligible for Octagam 10% and 2 years of age or older to be eligible for the co-benefit for Octagam 5%

• Patients are not eligible to use this card if they are enrolled in a state or federally funded insurance program, including but not limited to Medicare, Medicaid, TRICARE, Veterans Affairs health care, a state prescription drug assistance program, or the Government Health Insurance Plan available in Puerto Rico (formerly known as “La Reforma de Salud”).
• Patient must have private insurance. Offer is not valid for cash paying patients. The value of this co-pay card is limited to a maximum of $12,500 per calendar year or the cost of patient co-pay in a 12-month period, whichever is less.
• This co-pay card is not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private insurance plan or other private health or pharmacy benefit programs.
• You must deduct the value of this co-pay card from any reimbursement request submitted to your private insurance plan, either directly by you or on your behalf.
• You are responsible for reporting use of the co-pay card to any private insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the co-pay card, as may be required. You should not use the co-pay card if your insurer or health plan prohibits use of manufacturer co-pay cards.
• Patient must be 18 years of age or older to be eligible for the co-pay benefit for Octagam 10% and 2 years of age or older to be eligible for the co-benefit for Octagam 5%.
• This co-pay card is not valid where prohibited by law.
• The benefit under the co-pay card program is offered to, and intended for the sole benefit of, eligible patients and may not be transferred to or utilized for the benefit of third parties, including, without limitation, third party payers, pharmacy benefit managers, or the agents of either.
• Co-pay card cannot be combined with any other savings, free trial or similar offer for the specified prescription cannot be combined with any other savings, free trial or similar offer for the specified prescription (including any program offered by a third party payer or pharmacy benefit manager, or an agent of either, that adjusts patient cost-sharing obligations, through arrangements that may be referred to as “accumulator” or “maximizer” programs).
• Third party payers, pharmacy benefit managers, or the agents of either, are prohibited from assisting patients with enrolling in the [coupon/co-pay card] program.
• Co-pay card will be accepted only at participating pharmacies.
• If your pharmacy does not participate, you may be able to submit a request for a rebate in connection with this offer.
• This co-pay card is not health insurance.
• Offer good only in the U.S. and Puerto Rico.
• Co-pay card is limited to 1 per person during this offering period and is not transferable.
• A co-pay card may not be redeemed more than once per 30 days per patient.
• No other purchase is necessary.
• No membership fee.
• Data related to your redemption of the co-pay card may be collected, analyzed, and shared with Pfizer for market research and other purposes related to assessing Pfizer's programs. Data shared with Pfizer will be aggregated and de-identified; it will be combined with data related to other co-pay card redemptions and will not identify you.
• Pfizer reserves the right to rescind, revoke or amend this offer without notice.
• Offer expires 12/31/2024.