Program Contact Info / Application Submission
Program	Pfizer Bridge Program for Somavert
Company	PfizerSom
Form	Download PDF
Address	P.O. Box 220746 Charlotte, NC 28222-0746
Phone	800-645-1280
Fax	800-479-2562
Website	http://www.pfizerhelpfulanswers.com/pages/Programs/programdetails.aspx?p=8
Program Requirements
Details	Insurance card NOT required Drivers license NOT required Proof of Income required Copy of most recent tax return such as 1040, 1099 NOT required as proof of income Letter from Doctor stating zero incomeNOT required as proof of income Form 4506T (If taxes were not filed) required as proof of income Most recent bank statements NOT required as proof of income Most recent check/check stub copy accepted as proof of income Letter from employer NOT required as proof of income Benefits statement for Social Security, Unemployment, Veterans Benefits, Pension/Retirement required as proof of income Award Letter for Alimony/Child Support, Unemployment required as proof of income Notarized statement from patient stating zero income NOT required as proof of income
Other Requirements	statement of medical necessity
Delivery of Medication
Ship Time	3 - 5 business days
Delivery Options	Can be delivered directly to the patient Delivery directly to the doctor will be considered on a case by case basis
Application Process
New Applications	New applications accepted Patients applying directly to the program will be considered on a case by case basis Doctors can NOT apply directly to the program Advocates applying directly to the program will be considered on a case by case basis Can NOT apply for a new application via phone Can apply for a new application via fax Can apply for a new application via mail
Refills	Refills accepted Patients can apply for refills Doctors can NOT apply for refills Advocates can NOT apply for refills Can apply for refills via phone Can NOT apply for refills via fax Can NOT apply for refills via mail
Re-Applications	Re-Applications accepted Patients can apply for Re-Applications Doctors can NOT apply for Re-Applications Advocates may apply for Re-Applications on a case by case basis Can NOT Re-Apply via phone Can Re-Apply via fax Can Re-Apply via mail
Appeals	Income Appeals accepted on a case by case basis Patients can apply for Income Appeals on a case by case basis Doctors can NOT apply for Income Appeals Advocates can apply for Income Appeals on a case by case basis Hardship Appeals accepted Patients can apply for Hardship Appeals Doctors can apply for Hardship Appeals on a case by case basis Advocates can apply for Hardship Appeals on a case by case basis Can NOT apply for an appeal via phone Can apply via fax Can apply for an appeal via mail
Appeals
Conditions	Appeals will consider out-of-pocket expenses Appeals may be consider total medical expenses on a case by case basis
Other Medications
Other  Medications  available in  this program	Somavert subcutaneous 10mg vials - Human Growth Hormone Hormone (Generic: pegvisomant) Somavert subcutaneous 15mg vials - Hormone (Generic: pegvisomant) Somavert subcutaneous 20mg vials - Hormone (Generic: pegvisomant)