For eligible patients
prescribed cutaquig,
Pfizer's cutaquig co-pay program may offer savings

Eligible, commercially insured patients may reduce out-of-pocket
costs by up to $12,500 per calendar year (renewed every
January)* or the cost of patient’s co-pay in a
12-month period, whichever is less

*Terms and conditions apply. See full terms and conditions below. Patients must be 2 years or older to be eligible. Patients must have commercial insurance to be eligible. Patients are not eligible if they are enrolled in a state or federally funded insurance program.

Specialty Infusion Pharmacies May Enroll Eligible Patients.

TERMS AND CONDITIONS

By using this co-pay card, you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions described below:

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.
The patient must be 2 years of age or older for redemption of co-pay card.
This co-pay card is not valid where prohibited by law.
Co-pay card cannot be combined with any other savings, free trial or similar offer for the specified prescription.
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 5 days per patient.
Co-pay card is limited to reimbursement of Pfizer-labeled CUTAQUIG^® (Immune Globulin Subcutaneous [Human] - hipp) only.
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 12/31/2023.

For more information, call 1-866-293-5922, or write:

CUTAQUIG Co-Pay Program
P.O. Box 6875
Bridgewater, NJ 08807

What is Pfizer IGuide^TM?

Pfizer IGuide^TM can help you understand your insurance coverage and out-of-pocket costs for your cutaquig prescription, as well as identify financial assistance options for which you may be eligible.

If you have been prescribed cutaquig and have questions about your coverage,
call Pfizer IGuide™ Monday through Friday, 8 AM to 8 PM ET, at 1-844-448-4337.

Financial Assistance

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

Commercially Insured Patients

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

Medicare/Government-Insured Patients

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

Uninsured Patients

If you do not have health insurance and cannot afford your cutaquig treatment, Pfizer IGuide^TM can connect you to potential resources that may help cover the cost of cutaquig, including how to apply to Medicaid if you may be eligible