Pfizer Hemophilia Connect offers support for patients, caregivers, and healthcare professionals. Once prescribed, our Patient Case Managers are here to help with information about insurance coverage, reimbursement eligibility, and educational resources to get started with XYNTHA.
Call Pfizer Hemophilia Connect at 1-888-733-2030, Monday through Friday, 8AM – 6PM ET to learn more.
Applying for assistance with factor treatment cost is easy
With the Pfizer Factor Savings Card, eligible patients who have been prescribed XYNTHA by their health care providers may save up to $12,000 per year toward their co-pay, deductible, and coinsurance costs. Terms and conditions apply. This co-pay card is not health insurance and is only available at participating pharmacies.
Save and print your card right from your computer. The card is now activated.
Keep your card and use it for every purchase until the maximum benefit has been reached or the card has expired, whichever comes first.
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How the program works under the medical benefit
1.Enroll in the Factor Savings Program
You will then be given an 11-digit member number/patient identifier.
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.
2.Co-pay collection
After you receive your factor treatment, your physician follows his or her standard procedure for co-pay collection.
3.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.
4.Complete and submit Co-pay Rebate Form
If the product is covered by your health insurance, you and/or your provider fill out a Co-pay Rebate 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 1-908-548-9260.*
The Factor Savings Program coordinator reviews the EOB and Co-pay Rebate Form and will determine approval status.
6.Payment
Your provider/treatment center will receive reimbursement via check. The check will be made out and sent via mail to the site address provided, unless otherwise indicated.
7.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 Factor Savings Card. Physician signature is required. Patient or physician must indicate if submitting enrollment for Factor Savings Card or reimbursement via check. All checks will go to the treatment site unless otherwise indicated.
If your doctor has prescribed XYNTHA, ask your care team about enrolling in Pfizer Hemophilia Connect to access support.
Patient Case Managers (PCMs) at Pfizer Hemophilia Connect provide live support to explain the insurance coverage process for XYNTHA, as well as help identify potential financial assistance based on eligibility.‡
To enroll, call Pfizer Hemophilia Connect at 1-888-733-2030, Monday through Friday, 8AM – 6PM ET.
‡PCMs can not guarantee insurance coverage or financial support.
Save on your factor costs
If you are eligible, you can register for the Pfizer Factor Savings Card. Please answer the following questions to register.
All fields are required unless marked as optional
Eligibility questions
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Trial Prescription Program
Helping eligible patients access proven bleed control and protection for free.
With the program, patients prescribed XYNTHA for the first time may be eligible to receive a 1-time, 1-month trial supply up to 20,000 IU at no cost.
This program is only available for first-time use by commercially insured patients. Medicare/Medicaid beneficiaries are not eligible. Terms and conditions apply.
To find out if you’re eligible, please download the enrollment form and bring it with you to your health care provider to complete and submit.
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Patient Navigators (PNs)
Pfizer Patient Navigators (PNs) can provide educational resources and help connect patients with community-based support.
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XYNTHA resources for healthcare professionals (HCPs)
Starting a new treatment is different for every patient. Pfizer Hemophilia Connect provides resources and support to help get eligible patients started on XYNTHA. Access & Reimbursement Managers (ARMs) are available to help HCPs and HCP office staff to answer questions about access, coverage, and reimbursement.
Sample Letter of Medical Necessity
Reference the Sample Letter of Medical Necessity to justify the clinical need for XYNTHA.
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Sample Letter of Appeal
Reference the Sample Letter of Appeal to respond to denials and support insurance appeals for XYNTHA.
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Pfizer Hemophilia Connect Enrollment Form
Complete and submit the form to enroll patients in support programs for XYNTHA.
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To learn more about XYNTHA
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Hemophilia Factor Savings Card Offer Terms and Conditions
By using the Pfizer Factor Savings Card, you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions described below:
Eligible patients with commercial prescription drug insurance coverage for Benefix or Xyntha may pay as little as $0 per prescription fill. Patient out of pocket expense will vary. The value of this offer is limited to annual benefit of $12,000. Once a patient reaches the annual maximum benefit patient is responsible for paying the remaining monthly out of pocket costs.
Patients are not eligible for this offer if they are enrolled in a state or federally funded insurance program, including but not limited to Medicare, Medicaid, 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”).
Patient must have private insurance. Offer is not valid for cash paying patients.
This offer is not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private insurance plan or other private health or pharmacy benefit programs.
You must deduct the value of this offer from any reimbursement request submitted to your private insurance plan, either directly by you or on your behalf.
You are responsible for reporting use of the the Factor Savings Program to any private insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the co-pay card, as may be required. You should not use the co-pay card if your insurer or health plan prohibits use of manufacturer co-pay cards.
This co-pay card is not valid for Massachusetts residents whose prescriptions are covered in whole or in part by third party insurance.
This co-pay card is not valid where prohibited by law.
The benefit under the co-pay card program is offered to, and intended for the sole benefit of, eligible patients and may not be transferred to or utilized for the benefit of third parties, including, without limitation, third party payers, pharmacy benefit managers, or the agents of either.
Third party payers, pharmacy benefit managers, or the agents of either, are prohibited from assisting patients with enrolling in the co-pay card program.
Co-pay card cannot be combined with any other external savings, free trial or similar offer for the specified prescription (including any program offered by a third party payer or pharmacy benefit manager, or an agent of either, that adjusts patient cost-sharing obligations, through arrangements that may be referred to as “accumulator adjustment” or “co-pay maximizer” programs)
Some health insurers or pharmacy benefit managers (or their agents) may have established accumulator adjustment or co-pay maximizer programs based on the availability of support under the offer [coupon/co-pay card] program and/or exclude the financial assistance provided under the offer [coupon/co-pay card] program from counting towards patient deductibles or out-of-pocket cost limitations.
Patients subject to an accumulator adjustment or co-pay maximizer program are not eligible for this offer. Since you may be unaware whether you are subject to an accumulator adjustment or co-pay maximizer program when you enroll in this offer, Pfizer may monitor program utilization data and reserves the right to discontinue, reduce, or otherwise modify this offer at any time without notice
Co-pay card will be accepted only at participating pharmacies.
If your pharmacy does not participate, you may be able to submit a request for a rebate in connection with this offer.
This co-pay card is not health insurance.
Offer good only in the U.S. and Puerto Rico.
Co-pay card is limited to 1 per person during this offering period and is not transferable.
A co-pay card may not be redeemed more than once per 30 days per patient.
No other purchase is necessary.
Data related to your redemption of the co-pay 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 co-pay card redemptions and will not identify you.
Pfizer reserves the right to rescind, revoke or amend this offer without notice.
Offer expires 12/31/2026
For questions regarding the offer, please call 1-888-733-2030 or write Pfizer Hemophilia Connect, 600 Emerson Road, 3rd Floor, Suite 300, Creve Coeur, MO 63141
Co-pay Savings Card Rebate Terms and Conditions
By submitting this Pfizer Factor Savings Card rebate form, you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions described below:
Patients must have private insurance. Offer is not valid for cash-paying patients. 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. The Factor Savings Card cannot be combined with any other savings, free trial, or similar offers for the specified prescription.
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, Veterans 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”).
This rebate is not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private insurance plan or other private health or pharmacy benefit programs.
You will receive $12,000 or the amount of the co-pay you paid, whichever is less. This program is limited to a maximum of $12,000 per patient per year.
Patient must submit a completed rebate request form and the original, dated store-identified receipt accompanying your prescription as proof of purchase to Pfizer Hemophilia Connect at the address provided on this rebate form. Receipt will not be returned. See instructions on rebate request form.
Rebate will be mailed to patients approximately 6 to 8 weeks after receipt of required documentation or earlier, as required by law.
You must deduct the value received under this rebate from any reimbursement request submitted to your private insurance plan, either directly by you or on your behalf.
You are responsible for reporting receipt of rebate to any private insurer, health plan, or other third party who pays for or reimburses any part of the prescription for which the patient receives a rebate, as may be required. You should not use this program if your private insurer or health plan prohibits use of manufacturer coupons, co-pay cards, debit cards or similar savings programs.
This rebate is not valid where prohibited by law.
The benefit under the rebate program is offered to, and intended for the sole benefit of, eligible patients and may not be transferred to or utilized for the benefit of third parties, including, without limitation, third party payers, pharmacy benefit managers, or the agents of either.
This rebate cannot be combined with any other external savings, free trial or similar offer for the specified prescription (including any program offered by a third party payer or pharmacy benefit manager, or an agent of either, that adjusts patient cost-sharing obligations, through arrangements that may be referred to as “accumulator” or “maximizer” programs).
Third party payers, pharmacy benefit managers, or the agents of either, are prohibited from assisting patients with enrolling in the rebate program.
This rebate is not health insurance.
Offer good only in the U.S. and Puerto Rico.
No other purchase is necessary.
Data related to your redemption of the rebate 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 rebate redemptions and will not identify you.
Pfizer reserves the right to rescind, revoke or amend the program without notice.
This rebate program expires 12/31/2026.
Trial Prescription Program Terms and Conditions
By enrolling in the 1-month trial program for Pfizer Factor Product, you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions described below:
You (the patient) are currently covered by a private (commercial) insurance plan. The patient, or health care provider on the patient’s behalf, must provide a completed enrollment form and a valid prescription to the Pfizer Factor Product Trial Prescription Program. The program is valid for one 1-month trial of up to 20,000 IU of factor. Trial cannot exceed 30 days. The patient, or the health care provider on the patient’s behalf, must not submit any claim for reimbursement for product dispensed pursuant to this program to any third-party payer, including Medicaid, Medicare, or any other federal or state health care program. The patient must not apply the value of the free product received through this program toward any government insurance benefit out-of-pocket spending calculations, such as Medicare Part D True Out-of-Pocket Costs (TrOOP). The free trial offer is not valid for prescriptions that are eligible to be reimbursed by private insurance plans or health or pharmacy benefit programs that reimburse you for the entire cost of your prescription drugs. Patients who have already begun therapy with or who have been treated with Pfizer Factor Product are not eligible to participate in the program. Only new patients may use this offer. Only 1 program enrollment per person per lifetime. By enrolling in this program, you certify that you are not currently using Pfizer Factor Product. Program not available where prohibited by law. This free trial is not health insurance. This free trial is not intended to address delays or gaps in health insurance coverage for the specified prescription. This program cannot be combined with any other savings, free trial, or similar offers for the specified prescription. The free trial offer will only be accepted by participating factor providers. Offer good only in the United States and Puerto Rico. No purchase is necessary. Patients have no obligation to continue to use Pfizer Factor Product. This offer is not transferable. Pfizer reserves the right to rescind, revoke, or amend this free trial program without notice. This free trial program expires 12/31/26. No membership fees. For questions about the Pfizer Factor Product Trial Prescription Program, please call 1-844-989-HEMO (4366) or write to us at Pfizer Factor Product Trial Prescription Program Administrator, Medvantx, PO Box 5736, Sioux Falls, SD 57117-5736.
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What is XYNTHA?
XYNTHA® Antihemophilic Factor (Recombinant) is an injectable medicine that is used to help control and prevent bleeding in people with hemophilia A. Hemophilia A is also called classic hemophilia. Your doctor might also give you XYNTHA before surgical procedures.
XYNTHA is not used to treat von Willebrand’s disease.
Important Safety Information
Call your health care provider or go to the emergency department right away if you have any of the following symptoms because these may be signs of a serious allergic reaction: wheezing, difficulty breathing, chest tightness, turning blue (look at lips and gums), fast heartbeat, swelling of the face, faintness, rash, low blood pressure, or hives. XYNTHA contains trace amounts of hamster protein. You may develop an allergic reaction to these proteins. Tell your health care provider if you have had an allergic reaction to hamster protein.
Call your health care provider right away if bleeding is not controlled after using XYNTHA; this may be a sign of an inhibitor, an antibody that may stop XYNTHA from working properly. Your health care provider may need to take blood tests to monitor for inhibitors
Across all clinical studies, the most common side effects (10% or more) with XYNTHA in adult and pediatric previously treated patients were headache (24% of subjects), joint pain (23%), fever (23%), and cough (12%). Other side effects reported in 5% or more of patients were diarrhea, vomiting, and weakness.
XYNTHA is an injectable medicine administered by intravenous (IV) infusion. You may experience local irritation when infusing XYNTHA after reconstitution in XYNTHA® SOLOFUSE®.
The health information contained in this site is provided for educational purposes only and is not intended to replace discussions with a healthcare provider. All decisions regarding patient care must be made with a healthcare provider, considering the unique characteristics of the patient.