Besponsa

Indicated For

relapsed or refractory B-cell precursor acute lymphoblastic leukemia (B-ALL)

About This Medication

# Pfizer Patient Assistance Program Patient Guide: How to Get Besponsa (inotuzumab ozogamicin) at Low or No Cost Besponsa (inotuzumab ozogamicin) is a prescription medication used to treat adults with relapsed or refractory B-cell precursor acute lymphoblastic leukemia (ALL), a type of blood cancer. The **Pfizer Patient Assistance Program** provides **Besponsa at no cost** to eligible patients who meet specific income, insurance, and residency requirements, helping those who cannot afford their treatment.[1][4] ## Who Qualifies for the Program? This program is designed for patients facing financial hardship due to the high cost of Besponsa. To qualify, you must: - Be **18 years or older** and reside in the **U.S. or a U.S. territory**.[8] - Have a **valid prescription** from a U.S.-licensed healthcare provider for an **FDA-approved use** in an outpatient setting.[4] - Meet **income guidelines**: Your household income must be at or below **400% of the Federal Poverty Level (FPL)**, adjusted for family size.[program data] - Have **no commercial insurance**; eligibility is limited to **uninsured patients** or those insured through **government programs** like Medicare, Medicaid, CHAMPUS/TRICARE, or Veterans Affairs.[program data][4] **Important**: Commercially insured patients (e.g., employer-sponsored plans) are **not eligible**. You may need to exhaust other assistance options first, such as co-pay programs or state aid, and provide proof of denial.[4][9] ## About Besponsa (inotuzumab ozogamicin) **Besponsa** is an injectable chemotherapy drug that targets CD22-positive B-cell precursor ALL cells. It's typically given in cycles over several weeks by a healthcare professional. Common side effects include low blood cell counts, infection risk, liver problems, and infusion reactions—discuss these with your doctor. This program covers free medication for eligible patients, but it does not cover doctor visits, tests, or other care costs.[2] ## Income Eligibility Breakdown Eligibility is based on **400% of the FPL**, which changes yearly. Here's a sample table based on 2026 FPL guidelines (check www.pfizerrxpathways.com for current figures, as they adjust for family size and location): | Household Size | Annual Income Limit (400% FPL) | |----------------|-------------------------------| | 1 (Individual) | $60,240 | | 2 (Couple) | $81,760 | | 3 | $103,280 | | 4 | $124,800 | *Add ~$21,520 per additional person.* Income includes wages, Social Security, pensions, etc. Provide proof like tax returns (1040 pages 1-2), W-2s, pay stubs, or SSA-1099.[5][program data] Note: Oncology products like Besponsa may have varying thresholds up to 500-600% FPL in some cases, but this program uses 400%.[4] ## Insurance Requirements - **Eligible**: Uninsured or government-insured (Medicare, Medicaid, etc.). Include copies of insurance cards (front/back).[program data][8] - **Not Eligible**: Commercial/private insurance. Medicare patients may qualify if underinsured after denial.[4][8] - Tip: Use Pfizer Oncology Together for prior authorization or appeals help before applying here.[2] ## Step-by-Step Application Process 1. **Check Eligibility**: Visit www.PfizerRxPathways.com, use the Program Finder, enter "Besponsa," and input your details.[1][9] 2. **Gather Documents**: - Proof of income (e.g., 1040, W-2, pay stubs).[5] - Proof of residency (e.g., utility bill).[program data] - Proof of insurance status (cards or denial letters).[program data] - Prescription from your doctor.[program data] 3. **Complete Enrollment**: Download the form from PfizerRxPathways.com or call **1-866-293-5922**. Patient and doctor sign sections. Use online Pfizer PAP Connect if available, or mail/fax manually.[1][5] - Mail to: Pfizer Patient Assistance Program, P.O. Box 66585, St. Louis, MO 63166-6585 - Fax: 866-470-1748[5] 4. **Submit**: Doctor can fax with cover page; do **not** send medical records.[5] 5. **Wait for Approval**: Notified in **2-3 weeks**.[1][5] ## Timeline and Delivery - **Processing**: 2-3 weeks for enrollment status.[1] - **Reauthorization**: **Required** periodically—your doctor resubmits proof of continued need.[program data] - **Delivery**: Free medication shipped to your **doctor’s office or home**.[program data] Enrollment letter details next steps.[5] ## Alternatives if Denied - **Appeal**: Contact Pfizer at 1-866-293-5922 or explore Pfizer Oncology Together for co-pay cards (commercial insurance) or prior auth help.[2][3] - **Other Resources**: Search PfizerRxPathways.com for third-party aid; apply to all and provide denials.[9] Check state programs, NeedyMeds.org, or RxAssist.org.[7] - **Biosimilars**: None available for Besponsa.[program data] - **Medicaid/Other**: Program may help apply.[6] ## Disclaimer This guide is for informational purposes only and based on available program details as of 2026. Eligibility rules, income limits, and processes **can change**—always verify at www.PfizerRxPathways.com or by calling **1-866-293-5922**. Pfizer may require exhausting other aid first. Not medical advice; consult your doctor. Program provided by Pfizer Inc. and Pfizer Patient Assistance Foundation.[4][5] (Word count: 942)

Program information last verified: March 30, 2026