HOW THE PROGRAM WORKS
Enroll in the Factor Savings Program
You will then be given an 11-digit member number/patient identifier.ENROLL HERE
Eligible Patients: Commercially insured patients whose health insurance covers factor.
Enrollment in the Factor Savings Program ensures eligibility.
Noneligible Patients: Patients on government assistance health care programs.
After you receive your factor treatment, your physician follows his or her standard procedure for co-pay collection.
Explanation of Benefits (EOB)
Your provider then submits your claim to your health insurance company, after which you and your provider receive an EOB statement.
Enroll in the Virtual Debit Card Program
If the product is covered by your health insurance, you and/or your provider fill out a Virtual Debit Card enrollment form using your unique 11-digit member number. The enrollment form and the EOB must then be faxed to the Factor Savings Card Program at 1-844-250-7194.*DOWNLOAD FORM
The Factor Savings Program coordinator reviews the EOB and enrollment form, and, once approved, faxes the Factor Savings Virtual Debit Card details to your provider/treatment center.†
Your provider/treatment center uses the Factor Savings Virtual Debit Card to pay for your medication.
Submitting future claims
For each subsequent claim, an EOB may be submitted with your 11-digit member number/patient identifier to the same fax number in order to continue to receive benefits from the program.‡
*Please note: Patient or physician must provide the savings card member number on the form. Fax numbers for the site must be up to date if applying for a Virtual Debit Card. Physician signature is required. Patient or physician must indicate if submitting enrollment for Virtual Debit Card or reimbursement via check. All checks will go to the treatment site unless otherwise indicated.
†If applying for reimbursement via check, the check will be made out and sent via mail to the site address provided, unless otherwise indicated.
‡Maximum benefit is $12,000/year. To change payment vehicle from Virtual Debit Card to check or vice versa, please indicate this on the Virtual Master Card Enrollment Form.
OFFER TERMS: By using the Pfizer Factor Savings Card Virtual Debit 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 Medicaid, Medicare, TRICARE, Veteran 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”). Patients must have private insurance. Offer is not valid for cash-paying patients. Patients, or those authorized to act on their behalf, must use this debit card to pay for out-of-pocket costs for Pfizer Factor Product pursuant to a private insurance benefit. Patients must not use this Card for any other medical expenses or other purchases. Patients, or those authorized to act on their behalf, must submit proof of a qualified prescription and the patient’s out-of-pocket cost to the Pfizer Factor Savings Card Program at the address provided below for each debit card use in order to continue to use the debit card. Receipt will not be returned. Funds for the next prescription will not be loaded onto the debit card until the Pfizer Factor Savings Card Program has reconciled the claim against the proof-of-purchase documentation. The value of the Factor Savings Card is limited to $12,000 per calendar year or the amount of your co-pay over 1 year, whichever is less. This Card is not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private insurance plans or other health or pharmacy benefit programs. You must deduct the value of this Card from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf. You are responsible for reporting use of the Card to any private insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the Card, as may be required. You should not use the Card if your insurer or health plan prohibits use of manufacturer co-pay or debit cards. This Card is not valid where prohibited by law. The Card cannot be combined with any other savings, free trial, or similar offers for the specified prescription. This Card is not health insurances. Offer good only in the United States and Puerto Rico. The Card is limited to 1 per person during this offering period and is not transferable. No other purchase is necessary. Data related to your redemption of the 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 Card redemptions and will not identify you. Pfizer reserves the right to rescind, revoke, or amend this offer without notice. Offer expires 12/31/2020. No membership fees.
If you have questions, please call
1-844-989-HEMO (4366) or send questions to:
Pfizer Factor Savings Program
2250 Perimeter Park Drive, Suite 300, Morrisville, NC 27560