![]() Eligible patients will receive a rebate check. This Copay Assistance Card may only be used for prescription medication at participating pharmacies and other approved locations, and for the specific purpose (s) expressly authorized by AbbVie Inc. If your pharmacy does not accept the XELJANZ Co-pay Savings Card, you can use Xeljanz Co-pay Rebate Program which is another out-of-pocket cost support.įill out the XELJANZ Co-pay Rebate Form and Mailthe form and your pharmacy receipt in a stamped envelope to the address below. Providing the patient with financial assistance resources and information. When filling your next prescription at a retail pharmacy, like CVS or WalgreensĮvery time you refill your XELJANZ prescription. Determining eligibility for and helping eligible patients access co-pay. Please contact them for your specific cost. How much you will pay for your medicine is determined by your insurance company or your pharmacy. ![]() The information shows possible cost ranges. ![]() ![]() In a few steps, you can see what you may pay for some Pfizer medicines. When ordering your next shipment from your specialty pharmacy. Pfizer would like to help you understand what you may potentially pay for your medicine. By using the XELJANZ Instant Co-pay Savings Card,$0 per month co-pay,maximum benefit of $8,000 per calendar year.Īfter a maximum of $8,000, you will be responsible for paying the remaining monthly out-of-pocket costs. Offer subject to a monthly cap of wholesale acquisition cost plus usual and customary pharmacy charges and a separate annual cap of 9,100. ![]()
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