Provera

Indicated For

abnormal uterine bleeding, amenorrhea

About This Medication

# Pfizer Patient Assistance Program Patient Guide: How to Get Provera at Low or No Cost ## About This Program The **Pfizer Patient Assistance Program** is designed to help eligible patients access Pfizer medications, including Provera (medroxyprogesterone), at no cost or reduced cost. This program is a joint initiative of Pfizer Inc. and the Pfizer Patient Assistance Foundation, a separate legal entity dedicated to helping patients afford their medications. ## About Provera (Medroxyprogesterone) Provera is a prescription medication manufactured by Pfizer that contains medroxyprogesterone, a synthetic progestin used for various medical purposes as prescribed by your healthcare provider. Like all prescription medications, Provera can be expensive, especially for uninsured or underinsured patients. The Pfizer Patient Assistance Program helps bridge this gap by providing the medication at no cost to qualifying patients. ## Who Can Qualify for This Program? To be eligible for the Pfizer Patient Assistance Program, you must meet the following requirements: - **Have a valid prescription** written by a healthcare provider licensed in the United States, Puerto Rico, or US Virgin Islands - **Be treated in an outpatient setting** by a licensed healthcare provider - **Live in the United States, Puerto Rico, or US Virgin Islands** - **Meet income requirements** based on the Federal Poverty Level (see income eligibility section below) - **Not have commercial insurance** that covers the medication (patients with commercial insurance are not eligible, even if the medication is not covered by their plan) - **Be unable to afford the medication** after reviewing insurer-required product costs with your provider or pharmacy Other requirements may apply depending on your specific situation. If you're unsure whether you qualify, you can call a Pfizer Medicine Access Counselor at **1-844-989-PATH (7284)** to discuss your eligibility. ## Income Eligibility To qualify for assistance, your **annual pre-tax household income must be at or below 300% of the Federal Poverty Level**. The Federal Poverty Level changes annually and varies based on household size. Here's an approximate breakdown of the 300% Federal Poverty Level threshold by household size (2025 estimates): | Household Size | Approximate Annual Income Limit | |---|---| | 1 person | $21,870 | | 2 people | $29,430 | | 3 people | $36,990 | | 4 people | $44,550 | | 5 people | $52,110 | | 6 people | $59,670 | | 7 people | $67,230 | | 8 people | $74,790 | *Note: These figures are estimates and may change annually. Contact the program for current thresholds.* ## Insurance Requirements **Important:** Patients with commercial insurance are **not eligible** for the Pfizer Patient Assistance Program, even if their insurance does not cover Provera or if they have high out-of-pocket costs. If you have Medicare, you may be required to first enroll in the voluntary Medicare Prescription Payment Plan for applicable products before being considered for the Pfizer Patient Assistance Program. In some cases, you may be required to seek alternate forms of assistance before you can be considered for free medicine through this program. ## Step-by-Step Application Process ### Step 1: Gather Required Documents Before starting your application, collect the following: - **Proof of income** (choose one): - Pages 1 and 2 of your previous year's federal tax return (Form 1040 or 1040EZ) - Wage and tax statements (W-2 forms) - Two recent paycheck stubs - Social Security, pension, or railroad retirement statements (SSA-1099 or similar) - **Valid prescription** from your healthcare provider - **Completed enrollment form** (available online or from your healthcare provider) ### Step 2: Complete the Enrollment Form You have two options for completing your application: **Option A: Online Application (Pfizer PAP Connect)** For certain Pfizer medicines, you can apply completely online through Pfizer PAP Connect: 1. Visit the Pfizer RxPathways website or Pfizer PAP Connect portal 2. Create a new account or log in if you're already enrolled 3. Enter your email, name, and other required information 4. Upload your eligibility documents (proof of income) 5. Complete and submit your application 6. Track your application progress online **Option B: Paper Application** If you prefer not to apply online or are unable to do so: 1. Download the enrollment form from the Pfizer RxPathways website or request one from your healthcare provider 2. Complete the patient section of the form 3. Have your healthcare provider complete and sign the prescriber section 4. Attach proof of income documentation 5. Mail or fax your completed application to: - **Mailing Address:** 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 are completed and signed. Do not submit medical records or other documentation that hasn't been specifically requested, as this may cause your application to be rejected. ## Timeline and Delivery **Processing Time:** You will be notified of your enrollment status **within 2 to 3 weeks** of submitting your application. **If Approved:** You will receive a letter that includes: - Your enrollment term (how long you're approved for) - Instructions on how you will receive your medication through the program - Information about refills and ongoing support **Medication Delivery:** The specific delivery method varies depending on your situation and the program's current procedures. Your approval letter will provide complete details. ## What If Your Application Is Denied? If your application is denied, you have the right to appeal. Your denial letter will include information about the appeal process and requirements for appealing a denied claim. You can also contact a Pfizer Medicine Access Counselor at **1-844-989-PATH (7284)** to discuss your options and explore other financial assistance resources that may be available to you. ## Alternatives and Additional Resources If you don't qualify for the Pfizer Patient Assistance Program or if your application is denied, other options may be available: - **Medicare Extra Help:** If you're turned down for Medicare Extra Help, you may be evaluated for eligibility in the Pfizer Patient Assistance Program - **Other financial assistance programs:** Pfizer can help you identify and access other co-pay support or free drug programs - **Healthcare provider resources:** Your healthcare provider or pharmacy may have information about other assistance programs - **Community health centers:** Federally qualified health centers may offer reduced-cost medications ## Important Disclaimers - Eligibility rules are subject to change at any time - This guide provides general information and is not a substitute for official program documentation - For the most current and complete information, visit www.PfizerRxPathways.com or call 1-844-989-PATH (7284) - The Pfizer Patient Assistance Foundation is a separate legal entity from Pfizer Inc. with distinct legal restrictions - By applying, you authorize Pfizer to determine your eligibility for assistance and to communicate with your healthcare providers about your Pfizer medicine and patient support activities ## Contact Information **Pfizer Medicine Access Counselors:** 1-844-989-PATH (7284) **Website:** www.PfizerRxPathways.com **Mailing Address:** Pfizer Patient Assistance Program, P.O. Box 66585, St. Louis, MO 63166-6585 **Fax:** 866-470-1748 A Pfizer Medicine Access Counselor can help you understand your eligibility, guide you through the application process, and answer any questions you have about the program.

Program information last verified: March 30, 2026