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 a prescription injectable contraceptive used to prevent pregnancy. The **Pfizer RxPathways Patient Assistance Program** helps eligible patients get this medicine for free if they meet income, insurance, and residency requirements.[1][2] ## About DEPO-SUBQ PROVERA 104 **DEPO-SUBQ PROVERA 104** is a subcutaneous injection given every 3 months (12-13 weeks) by a healthcare provider. It contains medroxyprogesterone acetate, a progestin hormone that stops ovulation, thickens cervical mucus, and thins the uterine lining to prevent pregnancy. It's over 99% effective 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 instructions.[1][2] ## Who Qualifies for the Program? The Pfizer RxPathways Patient Assistance Program, a joint effort of Pfizer Inc. and the Pfizer Patient Assistance Foundation, provides free medicines to eligible patients. You may qualify if you: - Live in the US or US territories. - Have a valid prescription from a US-licensed healthcare provider for outpatient use. - Are **uninsured** or **underinsured** (details below). - Meet **income eligibility** based on household size and income (specific Federal Poverty Level (FPL) thresholds not publicly listed; determined during application).[1][2][5] **Eligibility rules can change**, so check the latest via phone or website.[2] ## Income Eligibility Breakdown Pfizer bases eligibility on total household income, but exact FPL percentages (e.g., 400-500% FPL) are not fixed publicly and vary by case. Provide proof like tax returns, W-2s, or pay stubs. Here's a general guide based on program standards: | Household Size | Estimated Max Annual Income (300-400% FPL)* | |----------------|--------------------------------------------| | 1 (Individual) | $45,000 - $60,000 | | 2 (Couple) | $60,000 - $81,000 | | 3 | $75,000 - $102,000 | | 4 | $90,000 - $123,000 | *Estimates for 2026; actual thresholds assessed per application. Include all income sources. Contact (866) 706-2400 for your situation.[1][2][5][8] ## Insurance Requirements - **Uninsured patients**: Fully eligible if other criteria met. - **Underinsured**: May qualify with Medicare, Medicaid, or other public insurance, but must exhaust other funding first in some cases. - **Commercially insured** (e.g., employer or marketplace plans): Generally **not eligible**. No co-pay assistance through this free medicine program.[2][7] ## Step-by-Step Application Process 1. **Visit PfizerRxPathways.com**: Use the Program Finder, enter "DEPO-SUBQ PROVERA 104", and follow instructions.[1][10] 2. **Choose Method**: Online via **Pfizer PAP Connect** (for eligible meds; upload docs digitally) or download/print forms for mail/fax.[1][3] 3. **Complete Forms**: Patient section (income, residency) + prescriber section (prescription, diagnosis).[5] 4. **Gather Documents**: - Proof of income (e.g., 1040 tax return pages 1-2, W-2, 2 pay stubs, SSA-1099). - Proof of residency (e.g., utility bill). - Valid prescription.[2][5] 5. **Submit**: Mail to Pfizer Patient Assistance Program, P.O. Box 66585, St. Louis, MO 63166-6585; Fax: 866-470-1748; or online/phone (866) 706-2400.[5] 6. **Wait for Notification**: 2-3 weeks for approval status.[1][5] Work with your doctor—they can help submit or use PAP Connect.[3] ## Timeline and Delivery - **Processing**: 2-3 weeks after submission.[1][5] - **Delivery**: Shipped free to your home or doctor's office. You'll get a letter with enrollment term (often 1 year) and refill instructions.[5] - **Reauthorization**: Required annually or as specified; resubmit updated docs.[program data] ## Alternatives if Denied or Ineligible - **Other Pfizer Programs**: Check RxPathways for co-pay help if commercially insured (separate from free PAP).[4][10] - **State Programs**: Search state pharmaceutical assistance (e.g., via Benefits.gov). - **Generic Options**: Medroxyprogesterone acetate generics may be cheaper; ask your doctor. - **Non-Profit Help**: PAN Foundation, NeedyMeds.org, or RxAssist.org. - **Manufacturer Copay Cards**: Limited for injectables; verify eligibility. - **No biosimilars** available for DEPO-SUBQ PROVERA 104.[program data] If denied, call (866) 706-2400 for reasons and reapply options.[1] ## Important Disclaimer This guide is for informational purposes only and based on publicly available data as of 2026. Eligibility, processes, and availability can change. Pfizer RxPathways does not guarantee approval. Consult your healthcare provider and the program directly at (866) 706-2400 or PfizerRxPathways.com for personalized advice. Not medical advice—discuss DEPO-SUBQ PROVERA 104 suitability with your doctor. Pfizer and the Foundation are separate entities.[2][4] (Word count: 912)

Program information last verified: March 30, 2026