GENOTROPIN committed to personalized patient support
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1 active malignancy. Because growth hormone deficiency may be a sign of pituitary or other brain tumors, the presence of such tumors should be ruled out before trement is initied. Somropin should not be used in pients with any evidence of progression or recurrence of an Somropin should not be used to tre pients with acute critical illness due to complicions from surgery, trauma, or respirory failure; the safety of continuing somropin trement for approved uses in pients Prader-Willi syndrome who are severely obese or have respirory impairment. GENOTROPIN is contraindiced in pients with a known hypersensitivity to somropin or any of Please see accompanying full prescribing informion in pocket. personalized Please see accompanying full prescribing informion in pocket and on page 2. Please see accompanying full prescribing informion in pocket and on page 2.
2 GENOTROPIN committed to per The Pfizer Bridge Program offers expert advice to help navige through the insurance process E-Z Check thoroughly investiges insurance coverage Through E-Z Check, the Pient Care Consultant (PCC), a dediced advoce for your pients GH reimbursement needs, conducts an in-depth investigion of your pient s benefits and informs the office and pient of GENOTROPIN formulary stus. If GENOTROPIN is covered/ preferred, the PCC will: If GENOTROPIN is non-preferred, or not covered, the PCC will: FAST TRACK the case through the Prior Authorizion process (when required) to start GENOTROPIN therapy provided insurance requirements are met Advise the office of the therapy start de if device training is provided by Pfizer If necessary, up to 3 levels of appeal on behalf of the pient is provided by Pfizer Offer the GENOTROPIN Copay Program if there is a cost differential above a preferred product Provide formulary listing informion, along with associed out-of-pocket costs if available If necessary, up to 2 levels of appeal on behalf of the pient is provided by Pfizer Upon approval, the PCC SENDS THE PRESCRIPTION TO THE SPECIALTY PHARMACY. YOUR PATIENT WILL RECEIVE A CALL FROM THE PHARMACY TO COORDINATE THE SHIPMENT. The Pfizer Bridge Program is there to help with insurance changes or reauthorizion The PCC coordines with the Specialty Pharmacy on reauthorizions 6 weeks prior to expirion During open enrollment, the PCC can help the pient select the best coverage option Pfizer Bridge Program Online offers convenient 24/7 access to online forms and pient informion and stus With pfizerbridgeprogram.com, you can send messages to the PCC or submit online SMNs * Powered by Pfizer Helpful Answers. Provided clinical supporting documention is available. Based on pient/family preference and as allowed by the payer. Some exclusions may apply. Some payers may require the physician/office or pient/family to submit the appeals. When disclosed by payer.
3 sonalized INTERIM CARE Support* The PFIZER BRIDGE PROGRAM PROVIDES GENOTROPIN Interim Care SUPPORT no cost to eligible pediric pients for up to 3 months The Interim Care program helps pients start or continue on GENOTROPIN therapy while they await reauthorizion or appeals outcome *Powered by Pfizer Helpful Answers. Interim Care must be requested by the physician, or sted as a preference by the physician. The pient must accept Interim Care in order to qualify for the program. To be eligible, pients must be 18 years of age, and receiving reimbursement support from the Pfizer Bridge Program. Qualified pediric pients must also be diagnosed with an FDA-approved indicion for GENOTROPIN and must be US residents who are treed by US physicians. Some exclusions, limitions, and additional criteria may apply. Pfizer reserves the right to rescind, revoke, or amend this offer without notice. copay and coinsurance Support Financial support helps bring GENOTROPIN therapy into reach for more clinically-approprie pients The GENOTROPIN Copay Program* may save money on copays and coinsurance for your pients with commercial coverage Copay support Pients can save up to $125 per month ($1500 per year) in copays 95% of GENOTROPIN pients pay <$125 per month in copays Coinsurance Support Pients with a coinsurance payment of $200 per month pay only $75 per prescription The GENOTROPIN Copay Program pays the remainder of their GENOTROPIN coinsurance, up to $4000 per year * The GENOTROPIN Copay Program is not health insurance. This copay/coinsurance is available participing pharmacies. Pfizer reserves the right to rescind, revoke, or amend this offer without notice. No membership fee. Some restrictions apply. Includes coinsurance. Excludes coinsurance. As of June Pients must meet financial criteria in order to qualify for GENOTROPIN Coinsurance Support. Please see accompanying full prescribing informion in pocket and on page 2.
4 active malignancy. Because growth hormone deficiency may be a sign of pituitary or other brain tumors, the presence of such tumors should be ruled out before trement is initied. Somropin should not be used in pients with any evidence of progression or recurrence of an Somropin should not be used to tre pients with acute critical illness due to complicions from surgery, trauma, or respirory failure; the safety of continuing somropin trement for approved uses in pients Prader-Willi syndrome who are severely obese or have respirory impairment. GENOTROPIN is contraindiced in pients with a known hypersensitivity to somropin or any of Please see accompanying full prescribing informion in pocket. personalized Please see accompanying full prescribing informion in pocket and on page 2. Please see accompanying full prescribing informion in pocket and on page 2.
5 active malignancy. Because growth hormone deficiency may be a sign of pituitary or other brain tumors, the presence of such tumors should be ruled out before trement is initied. Somropin should not be used in pients with any evidence of progression or recurrence of an Somropin should not be used to tre pients with acute critical illness due to complicions from surgery, trauma, or respirory failure; the safety of continuing somropin trement for approved uses in pients Prader-Willi syndrome who are severely obese or have respirory impairment. GENOTROPIN is contraindiced in pients with a known hypersensitivity to somropin or any of Please see accompanying full prescribing informion in pocket. personalized Please see accompanying full prescribing informion in pocket and on page 2. Please see accompanying full prescribing informion in pocket and on page 2.
6 active malignancy. Because growth hormone deficiency may be a sign of pituitary or other brain tumors, the presence of such tumors should be ruled out before trement is initied. Somropin should not be used in pients with any evidence of progression or recurrence of an Somropin should not be used to tre pients with acute critical illness due to complicions from surgery, trauma, or respirory failure; the safety of continuing somropin trement for approved uses in pients Prader-Willi syndrome who are severely obese or have respirory impairment. GENOTROPIN is contraindiced in pients with a known hypersensitivity to somropin or any of Please see accompanying full prescribing informion in pocket. personalized Please see accompanying full prescribing informion in pocket and on page 2. Please see accompanying full prescribing informion in pocket and on page 2.
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