VIZIMPRO

Indicated For

Metastatic non-small cell lung cancer (NSCLC) with EGFR exon 19 deletion or exon 21 L858R substitution mutations

About This Medication

# Pfizer Oncology Together Patient Assistance Program Patient Guide: How to Get VIZIMPRO (dacomitinib) at Low or No Cost VIZIMPRO (dacomitinib) is a prescription medication used to treat certain types of non-small cell lung cancer (NSCLC) with specific genetic mutations. The **Pfizer Oncology Together Patient Assistance Program** provides **VIZIMPRO at no cost** to eligible patients who meet income and insurance criteria, helping those facing financial barriers to access this important therapy. ## About VIZIMPRO (dacomitinib) **VIZIMPRO** is an oral tyrosine kinase inhibitor that targets epidermal growth factor receptor (EGFR) mutations in metastatic NSCLC. It's typically taken once daily and plays a key role in first-line treatment for patients with EGFR exon 19 deletion or exon 21 L858R substitution mutations, as detected by an FDA-approved test. Common side effects include diarrhea, rash, nail toxicity, and mouth sores—your doctor will monitor these and provide management tips. Always follow your healthcare provider's instructions, and never stop or change your dose without consulting them. This program ensures you can continue treatment without cost concerns if you qualify. ## Who Qualifies for the Program? Eligibility focuses on **financial need** and **insurance status**. Key requirements include: - **Income at or below 500% of the Federal Poverty Level (FPL)**, adjusted for family size. - **Uninsured** or insured through government programs like **Medicare, Medicaid, CHAMPUS/TRICARE, or Veterans Affairs**. - **Commercially insured patients are not eligible**—this program is for those without private insurance coverage. - You must be unable to afford your out-of-pocket costs, even after understanding your prescription expenses and annual maximums. - For Medicare Part D/Advantage patients: Sign a certification, provide proof of enrollment in the Medicare Prescription Payment Plan, and confirm you haven't met your annual out-of-pocket maximum (no $0 co-pay yet). Patients on Social Security Disability or military health insurance may face restrictions—call to confirm. ## Income Eligibility Breakdown The program uses **500% of the FPL** as the threshold. Here's a table with 2026 guidelines (FPL updates annually; verify current levels via the program): | Household Size | Annual Income Limit (500% FPL) | |----------------|-------------------------------| | 1 (Individual) | $75,300 | | 2 (Couple) | $102,000 | | 3 | $128,700 | | 4 | $155,400 | | 5 | $182,100 | | Add per person | +$26,700 | *Notes: These are approximate based on 2026 continental U.S. FPL. Alaska/Hawaii have higher limits. Opt for electronic income verification or submit last year's tax return/1099s. Contact the program for exact figures and adjustments.* ## Insurance Requirements - **Eligible**: No insurance or government insurance (Medicare, Medicaid, etc.). - **Not Eligible**: Commercial/private insurance. If commercially insured, explore Pfizer Oncology Together co-pay programs instead. - Medicare patients must attest to eligibility and provide documentation. Work with your doctor/pharmacy/insurer to confirm costs before applying. ## Step-by-Step Application Process 1. **Check Eligibility**: Review income and insurance criteria. Use the online tool at [pfizeroncologytogether.com/patient](https://www.pfizeroncologytogether.com/patient) or call **(877) 744-5675** (Mon-Fri, 8 AM–8 PM ET). 2. **Gather Documents**: Prepare the **Patient Assistance Program Form** (download from site). Include income proof if not using electronic verification (tax returns, pay stubs). Your doctor completes the HCP section. 3. **Apply Online (Preferred)**: Visit [https://www.pfizeroncologytogether.com/patient](https://www.pfizeroncologytogether.com/patient), select VIZIMPRO, and complete the webform. Or use Pfizer PAP Connect for certain meds. 4. **Alternative Methods**: - **Phone**: Call (877) 744-5675 for assistance. - **Fax/Mail**: HCP faxes to 1-877-736-6506 or mails to Pfizer Oncology Together, PO Box 220366, Charlotte, NC 28222-0366. 5. **Submit**: Patient and HCP sign. Opt for electronic income check by providing mobile number. 6. **Follow Up**: Pfizer reviews; they may contact for more info. Prior authorization (if needed) should be approved first. The process is patient-friendly—Pfizer Oncology Together guides you every step. ## Timeline and Delivery Processing time varies but expect **2-4 weeks** for approval (call for updates). If approved, **VIZIMPRO ships free** to your doctor's office or pharmacy for pickup. No specific delivery method detailed—confirm upon approval. Refills require reapplication or reauthorization (details in approval letter). ## Alternatives if Denied - **Appeal**: Provide additional income/insurance docs. - **Co-Pay Programs**: For commercially insured via Pfizer Oncology Together (different eligibility). - **Other Assistance**: Pfizer helps find Medicaid or state programs. Call (877) 744-5675. - **Pfizer RxPathways**: Broader tool at pfizerRxPathways.com for more options. - **Government Aid**: Apply for Medicaid/CHIP if uninsured. Don't give up—support teams explore all avenues. ## Important Disclaimer This guide is for informational purposes only and based on publicly available program details as of 2026. Eligibility, terms, and FPL levels can change—**always verify directly with Pfizer Oncology Together at (877) 744-5675 or the website**. Not medical advice; consult your doctor for treatment decisions. Pfizer reserves rights to modify/terminate the program. Income tables approximate; official verification required. 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Program information last verified: March 30, 2026