DEPO-SUBQ PROVERA 104

Indicated For

contraception

About This Medication

# Pfizer RxPathways Patient Assistance Program Patient Guide: How to Get DEPO-SUBQ PROVERA 104 at Low or No Cost DEPO-SUBQ PROVERA 104 (medroxyprogesterone acetate) is an injectable contraceptive medication used to prevent pregnancy for up to 3 months with each dose. The **Pfizer RxPathways Patient Assistance Program** provides this medicine **free** to eligible patients who meet income and insurance criteria, helping those facing financial hardship access essential care.[1][2][4] ## About DEPO-SUBQ PROVERA 104 **DEPO-SUBQ PROVERA 104** is a subcutaneous (under-the-skin) injection of medroxyprogesterone acetate, a progestin hormone that prevents ovulation, thickens cervical mucus, and thins the uterine lining to stop pregnancy. Administered every 12-13 weeks by a healthcare provider, it offers **99% effective contraception** when used correctly. Common side effects include irregular bleeding, weight gain, headaches, and mood changes; discuss risks like bone density loss with your doctor, especially for long-term use. Always follow your provider's guidance for safe use.[1][2] ## Who Qualifies for the Program? The Pfizer RxPathways program targets **financially needy patients** treated outpatient in the US with a valid prescription from a US-licensed provider. Key requirements: - **US residency** and outpatient treatment. - **Financial need**: Proof of income required, though exact thresholds are **not publicly disclosed**—eligibility is determined case-by-case.[1][2][5][9] - **Insurance status**: Uninsured or underinsured (e.g., Medicare, Medicaid, or private plans with insufficient coverage). **Commercially insured patients** (job-based or employer plans) are **not eligible**.[2][6] Patients may need to exhaust other funding sources first. Eligibility can change; check www.PfizerRxPathways.com.[1][2] ## Income Eligibility Breakdown Pfizer does **not disclose specific income limits** (e.g., Federal Poverty Level percentages), unlike some programs. Applications are reviewed individually based on submitted proof of income. Common documents include: | Household Size | Threshold Example (Not Official) | Required Proof | |---------------|---------------------------------|---------------| | Individual | Undisclosed | Tax return (1040 pages 1-2), W-2, 2 paystubs, SSA-1099 [2][5] | | Couple | Undisclosed | Same as above [5] | | Family of 3 | Undisclosed | Same as above [5] | | Family of 4+ | Undisclosed | Same as above [5] | **Notes**: Provide **total household income**. Electronic verification possible; opt-out requires documents. Reapplicants check 'reapplying' box.[2][5][6][9] Contact (866) 706-2400 for guidance.[1] ## Insurance Requirements - **Eligible**: No prescription coverage or **insufficient coverage** (e.g., Medicare Part D with high copays, Medicaid gaps).[2] - **Ineligible**: Commercial/employer insurance—even if copays are high.[2][6] Confirm status; program verifies coverage. Medicare patients may qualify if underinsured.[2] ## Step-by-Step Application Process 1. **Visit Pfizer RxPathways**: Go to www.PfizerRxPathways.com, use **Program Finder**, enter **DEPO-SUBQ PROVERA 104**.[1][7] 2. **Choose Method** (multiple options): - **Online (Pfizer PAP Connect)**: For select medicines—create account (new patients: email/name; enrolled: add Patient ID). Upload docs, track status. Doctors register with NPI first.[3][10] - **Manual**: Download enrollment form; patient and doctor complete/sign.[5] - **Phone**: Call **(866) 706-2400** for help.[1] 3. **Gather Documents**: - Signed enrollment form (patient + prescriber sections).[5] - **Proof of income**: 1040 tax pages, W-2, paystubs, SSA-1099.[2][5][6] - Prescription; no medical records unless requested.[5] 4. **Submit**: - Online: Via PAP Connect.[3] - Mail: Pfizer Patient Assistance Program, P.O. Box 66585, St. Louis, MO 63166-6585.[5] - Fax: 866-470-1748 (prescriber cover page).[5] 5. **Wait for Notification**: 2-3 weeks.[1][5] **Tip**: Doctor's office can assist; use PAP Connect for speed.[1][3] ## Timeline and Delivery - **Processing**: **2-3 weeks** for approval notice.[1][5] - **Delivery**: If approved, letter details pickup/shipment (e.g., doctor's office or mail). Program provides **free medicine** for enrollment period (typically 1 year; reapply).[1][4][5] - **Refills**: Enrolled patients request via PAP Connect or phone.[3][10] ## Alternatives if Denied - **Appeal**: Contact (866) 706-2400 to review denial (e.g., income, insurance).[1] - **Other Programs**: Check NeedyMeds, RxAssist, or state assistance. Pfizer offers copay savings for commercially insured (separate).[7] - **Biosimilars**: None listed for DEPO-SUBQ PROVERA 104.[program data] - **Generic Options**: Discuss medroxyprogesterone alternatives with provider. - **RxPathways Counselor**: Call 1-844-989-PATH (7284).[7] ## Disclaimer This guide summarizes publicly available info as of latest data; **rules change**—verify at www.PfizerRxPathways.com or (866) 706-2400. Not medical/financial advice. Consult your doctor/pharmacist. Pfizer RxPathways is a joint Pfizer Inc./Pfizer Patient Assistance Foundation program; eligibility not guaranteed. Income docs must be accurate; falsification disqualifies.[1][2][4][5] (Word count: 942)

Program information last verified: March 30, 2026