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To submit a medical co-pay claim you will need:

  • Explanation of Benefits (EOB) form for insured patients
  • Pfizer Co-pay Claim Form

Please note: You may only submit a claim if the patient is commercially insured and is not participating in any Federal Healthcare Program (including Medicare, Medicaid, Tricare, or any other state or federal medical pharmaceutical benefit program or pharmaceutical assistance program).

Download the Pfizer Co-pay Claim Form