Cibinqo

Indicated For

moderate-to-severe atopic dermatitis

About This Medication

# Pfizer Patient Assistance Program Patient Guide: How to Get Cibinqo at Low or No Cost ## About This Program The **Pfizer Patient Assistance Program (PAP)** provides free or low-cost Cibinqo (abrocitinib) to eligible patients who cannot afford their medication. Cibinqo is a prescription medicine used to treat atopic dermatitis. If you meet the program's income and insurance requirements, you may qualify for free medication shipped directly to your healthcare provider's office. ## About Cibinqo Cibinqo is an FDA-approved prescription medication prescribed by dermatologists and other healthcare providers to treat moderate to severe atopic dermatitis. Like all prescription medications, it requires a valid prescription from a licensed US healthcare provider and must be used in an outpatient setting. ## Who Qualifies for This Program? To be eligible for the Pfizer Patient Assistance Program for Cibinqo, you must meet ALL of the following requirements: **Insurance Status:** - Be uninsured, OR - Be underinsured (have insurance but cannot afford your out-of-pocket costs), OR - Be a Medicare patient who meets income criteria and cannot afford your prescription costs - **Important:** Patients with commercial insurance (insurance through an employer or Federal Employer Plan) are NOT eligible **Income Requirements:** Your household income must not exceed 400% of the federal poverty level. Here are the 2026 income limits: | Household Size | Maximum Annual Income | |---|---| | Individual | $50,000 | | Couple (2 people) | $65,000 | | Family of 3 | $80,000 | | Family of 4 | $95,000 | For larger households, contact the program directly at (844) 989-7284 for your specific income limit. **Other Requirements:** - Be 18 years of age or older - Reside in the United States or a US territory - Have a valid prescription for Cibinqo written by a US-licensed healthcare provider - Have an FDA-approved diagnosis for which Cibinqo is prescribed - Not be enrolled in certain other assistance programs (in some cases) ## Insurance Requirements Explained **If you have NO insurance:** You are eligible to apply. **If you have commercial insurance (through your job or a Federal Employer Plan):** You are NOT eligible for this program. You may want to explore your insurance company's co-pay assistance programs instead. **If you have Medicare:** You may be eligible if you meet the income requirements AND cannot afford your out-of-pocket prescription costs. You must: - Be enrolled in the Medicare Prescription Payment Plan - Confirm you have not yet met your annual out-of-pocket maximum - Provide documentation of your Medicare enrollment **If you have Medicaid or state health insurance:** You may be eligible if you cannot afford your out-of-pocket costs and meet the income requirements. ## Step-by-Step Application Process ### Step 1: Gather Your Documents Before you start, collect the following required documents: - **Proof of Income:** One of the following: - Previous year's federal tax return (Form 1040 or 1040-EZ, pages 1 & 2) - W-2 forms from your employer - Two recent paycheck stubs - Social Security, pension, or railroad retirement statements (SSA-1099 or similar) - **Proof of Residency:** Documentation showing your US address - **Valid Prescription:** Your Cibinqo prescription from your healthcare provider - **Insurance Information:** Details about your current insurance coverage (or confirmation that you are uninsured) - **Medicare Information (if applicable):** Your Medicare ID number and Part D plan details ### Step 2: Complete the Enrollment Form You have two options for applying: **Option A: Apply Online (Recommended)** 1. Visit **www.pfizerpap.com** or use **Pfizer PAP Connect** on your computer or mobile device 2. Enter your Cibinqo prescription information 3. Follow the on-screen instructions 4. Upload your required documents 5. Submit your application **Option B: Apply by Mail or Fax** 1. Download or request the enrollment form from your healthcare provider or by calling (844) 989-7284 2. Complete and sign the patient section 3. Have your healthcare provider complete and sign the prescriber section 4. Gather your required documents (see Step 1) 5. Mail or fax to: - **Pfizer Patient Assistance Program** - **P.O. Box 66585** - **St. Louis, MO 63166-6585** - **Fax: 866-470-1748** ### Step 3: Submit Your Application Make sure all pages of your application and all required documents are included before submitting. Do NOT send medical records or other unrequested documents, as this may delay your application. ## Timeline and What to Expect **Processing Time:** You will be notified of your enrollment status within **2 to 4 weeks** of submitting your complete application. **If Approved:** - You will receive an approval letter with your enrollment term and next steps - Your Cibinqo will be shipped directly to your healthcare provider's office - Your provider will dispense the medication to you - You will need to reauthorize your enrollment periodically (your approval letter will specify when) **If Denied:** - You will receive a letter explaining why you were not approved - You may be able to reapply if your circumstances change - Contact the program at (844) 989-7284 to discuss your options ## Medication Delivery Once approved, your Cibinqo will be **shipped directly to your healthcare provider's office**. Your provider will then dispense it to you. This ensures your medication is handled safely and your provider can monitor your treatment. ## Reauthorization Your enrollment in the Pfizer Patient Assistance Program is not permanent. You will need to **reauthorize your enrollment** periodically. Your approval letter will specify when you need to reauthorize. When the time comes, you can reapply through the same process, and you may need to provide updated income documentation. ## What If Your Application Is Denied? If you are denied assistance, you have several options: 1. **Review the denial letter** to understand why you were not approved 2. **Reapply if circumstances change** (such as a change in income or insurance status) 3. **Contact the program** at (844) 989-7284 to discuss your situation and explore alternatives 4. **Ask your healthcare provider** about other assistance options or lower-cost alternatives 5. **Check if you qualify for other programs** such as state pharmaceutical assistance programs or manufacturer co-pay cards ## Important Reminders - **You must have a valid prescription** from a US-licensed healthcare provider to participate - **Income limits are strictly enforced** — your household income cannot exceed 400% of the federal poverty level - **Commercial insurance makes you ineligible** — if you have insurance through your job, you cannot use this program - **Reauthorization is required** — your enrollment will not continue indefinitely - **This program provides free medication only** — it does not cover doctor visits, lab tests, or other medical services ## Contact Information **For questions about the Pfizer Patient Assistance Program:** - **Phone:** (844) 989-7284 - **Website:** www.pfizerpap.com - **Hours:** Monday – Friday, 8 AM – 8 PM ET **For questions about Cibinqo or your prescription:** - Contact your healthcare provider or dermatologist ## Disclaimer This guide provides general information about the Pfizer Patient Assistance Program for Cibinqo. Program eligibility, requirements, and benefits are subject to change at any time. For the most current and complete information, visit www.pfizerpap.com or call (844) 989-7284. This guide is not a substitute for professional medical advice. Always consult your healthcare provider about your treatment options and eligibility for assistance programs.

Program information last verified: March 30, 2026