Call 1-877-744-5675 (Monday-Friday 8 AM-8 PM ET)

Navigating access and reimbursement.
Together.

If patients need access or reimbursement support for their prescribed Pfizer Oncology medications, we’re here to help.

Insurance Assistance

The process and paperwork related to insurance coverage can be daunting. If your patients need support, Pfizer Oncology Together is here to help.

PfizerOncologyPortal.com The secure Pfizer Oncology Together Provider Portal gives registered users 24/7 access to an online enrollment form and submission, along with real-time patient case information and helpful resources related to program offerings. With the portal, users can:

  • Complete and submit an online enrollment form to request multiple services for patients, such as:
    • Benefits verification, including eBV and ePA for certain payers
    • Co-pay assistance for certain injectable medications
    • Apply for financial assistance through the Pfizer Patient Assistance Program* for government insured, underinsured, or uninsured patients
  • Use electronic signatures for HCPs and patients to help complete the forms
  • Use secure messaging for inquiries and to upload documents
  • View case alerts and generate patient status reports
  • Access resources for certain injectable medications, including billing and coding guides and co-pay claims forms
CREATE AN ACCOUNT

*The Pfizer Patient Assistance Program is a joint program of Pfizer Inc. and the Pfizer Patient Assistance Foundation™. Free medicines from Pfizer are provided through the Pfizer Patient Assistance Foundation™. The Pfizer Patient Assistance Foundation™ is a separate legal entity from Pfizer Inc. with distinct legal restrictions.

We can conduct a benefits verification to determine a patient’s health insurance coverage and out-of-pocket costs. After verifying coverage, we’ll provide a summary of benefits for oral and injectable medications:

  • A summary of benefits will be faxed to you.
  • A call is made to the patient to review the summary of benefits verbally, and a copy is mailed to them, if requested.

We’ll coordinate with a patient’s insurer to determine the PA requirements, where and how to submit requests, and typical turnaround times. After your office submits a PA request, we’ll follow up with the insurer on behalf of the patient to track the progress and status, upon your request.

Below are sample templates and checklists that may be helpful in cases where additional information is required by the insurer.

Sample Letter of Medical Necessity

Download

Letter of Medical Necessity Checklist

Download

Prior Authorization Checklist

Download

We can review the reasons for a denied claim and help with the appeals process by providing information on payer requirements.

Sample Letter of Appeals

Letter of Appeal Checklist

GET INSURANCE FORMS AND RESOURCES

Find sample letters, checklists, and other insurance support resources on the Forms & Resources page.

Explore Resources

Give your patients financial information

Help your patients navigate their finances through educational tools and interactive modules.

Learn more

Product Access

To help your patients access the medication you’ve prescribed, we can identify specialty pharmacy options. If you prefer, you and your staff can also continue to work directly with specialty pharmacies.

BESPONSA® (inotuzumab ozogamicin), ELREXFIO™ (elranatamab-bcmm), and MYLOTARG™ (gemtuzumab ozogamicin) are available through a network of specialty distributors and specialty pharmacies.

Injectable biosimilars are available through most major wholesalers.

Specialty Pharmacies

Download

Specialty Distributors

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Please see full Prescribing Information for BESPONSA, including BOXED WARNING, or visit BESPONSAhcp.com.

Please see full Prescribing Information for ELREXFIO, including BOXED WARNING and Medication Guide, or visit ELREXFIOhcp.com.

Please see full Prescribing Information for MYLOTARG, including BOXED WARNING, or visit MYLOTARGhcp.com.

Billing & Coding Information

For your patient claim submissions, we provide easy access to sample forms and template letters, along with billing and coding information for physicians’ offices and hospital outpatient settings of care.†

Pfizer Oncology Biosimilars Q Codes:

In the physicians’ offices and hospital outpatient department sites of care, Medicare Administrative Contractors (MACs), private commercial payers, and Medicaid may recognize the following codes for reporting a biosimilar on claim forms.

Product HCPCS Code Descriptor
NIVESTYM® (filgrastim-aafi) Q5110
Injection, filgrastim-aafi, biosimilar, (NIVESTYM), 1 microgram
NYVEPRIA™ (pegfilgrastim-apgf) Q5122
Injection, pegfilgrastim-apgf, biosimilar, (NYVEPRIA), 0.5 mg
RETACRIT® (epoetin alfa-epbx)
Q5105
Q5106
Injection, epoetin alfa-epbx, biosimilar, (RETACRIT) (for ESRD on dialysis), 100 units
Injection, epoetin alfa-epbx, biosimilar, (RETACRIT) (for non-ESRD use), 1,000 units
RUXIENCE® (rituximab-pvvr) Q5119
Injection, rituximab-pvvr, biosimilar, (RUXIENCE), 10 mg
TRAZIMERA® (trastuzumab-qyyp) Q5116
Injection, trastuzumab-qyyp, biosimilar, (TRAZIMERA), 10 mg
ZIRABEV® (bevacizumab-bvzr) Q5118
Injection, bevacizumab-bvzr, biosimilar, (ZIRABEV), 10 mg
For additional billing and coding information, download the guides below.
BIOSIMILARS:

NIVESTYM BILLING & CODING GUIDE

NYVEPRIA BILLING & CODING GUIDE

RETACRIT Billing & Coding Guide

RUXIENCE Billing & Coding Guide

TRAZIMERA Billing & Coding Guide

ZIRABEV Billing & Coding Guide

BESPONSA® (inotuzumab ozogamicin) 

BESPONSA Sample UB-04/CMS-1450 Form For Hospital Outpatient Use

BESPONSA Sample CMS-1500 Form For Physician Office Use

ELREXFIO™ (elranatamab-bcmm)

ELREXFIO Billing & Coding Guide For Inpatient Use

ELREXFIO Billing & Coding Guide For Outpatient Use

MYLOTARG™ (gemtuzumab ozogamicin)

MYLOTARG Sample UB-04/CMS-1450 FORM FOR HOSPITAL OUTPATIENT USE

MYLOTARG Sample CMS-1500 Form For Physician Office Use

Please see full Prescribing Information for BESPONSA, including BOXED WARNING, or visit BESPONSAhcp.com.

Please see full Prescribing Information for ELREXFIO, including BOXED WARNING and Medication Guide, or visit ELREXFIOhcp.com.

Please see full Prescribing Information for MYLOTARG, including BOXED WARNING, or visit MYLOTARGhcp.com.

Please see full Prescribing Information for RETACRIT, including BOXED WARNING and Medication Guide, or visit RETACRIThcp.com.

Please see full Prescribing Information for RUXIENCE, including BOXED WARNING and Medication Guide, or visit RUXIENCEhcp.com.

Please see full Prescribing Information for TRAZIMERA, including BOXED WARNING, or visit TRAZIMERAhcp.com.

The sample forms are intended as a reference for billing and coding of BESPONSA, ELREXFIO, MYLOTARG, ZIRABEV, RUXIENCE, TRAZIMERA, RETACRIT, and NIVESTYM. These forms are not intended to be directive or to replace clinical decision-making, and the use of the recommended codes does not guarantee reimbursement. Healthcare providers may deem other codes or policies more appropriate and should select the coding options that most accurately reflect their internal guidelines, payer requirements, practice requirements, practice patients, and the services rendered.

Find a Local Field Reimbursement Manager (FRM) or Patient Access Navigator

Pfizer Oncology Field Reimbursement Managers (FRMs) and Patient Access Navigators are dedicated, specialized colleagues who can provide localized patient support to healthcare providers for medications in the Pfizer Oncology portfolio on behalf of your patients.

Find one in your area:

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Select a product
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SUBMIT

Please see full Prescribing Information for BESPONSA, including BOXED WARNING, or visit BESPONSAhcp.com.

Please see full Prescribing Information for DAURISMO (glasdegib), including BOXED WARNING and Medication Guide, or visit DAURISMOhcp.com.

Please see full Prescribing Information for MYLOTARG, including BOXED WARNING, or visit MYLOTARGhcp.com.

Please see full Prescribing Information for RETACRIT, including BOXED WARNING and Medication Guide, or visit RETACRIThcp.com.

Please see full Prescribing Information for RUXIENCE, including BOXED WARNING and Medication Guide, or visit RUXIENCEhcp.com.

Please see full Prescribing Information for SUTENT (sunitinib malate), including BOXED WARNING and Medication Guide, or visit SUTENThcp.com.

Please see full Prescribing Information for TRAZIMERA, including BOXED WARNING, or visit TRAZIMERAhcp.com.

Please see full Prescribing Information for ELREXFIO, including BOXED WARNING and Medication Guide, or visit ELREXFIOhcp.com.

This FRM and Patient Access Navigator locator is for healthcare professionals only. If you are a patient, call 1-877-744-5675 (Monday–Friday 8 AM–8 PM) for more information.

Visit the Patient Support page to learn more about how Pfizer Oncology Together can support your patients.

This Field Reimbursement Manager locator is for Healthcare Professionals only. If you are patient, call 1-877-744-5675 (Monday-Friday 8AM-8PM) for more information.

GET PATIENT SUPPORT