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Applications

Connection to Care™ Connection to care provides Pfizer medicines for free to qualified patients through their doctors' offices.

For new patient applications (general application)
Download New Patient Application in English
Download New Patient Application in Spanish
Download authorization form
Patients should also sign the authorization form above and give it to their doctors. It allows to share certain patient information with Pfizer in connection with the program. This form should not be returned with a patient's application.

For new patients (expedited product order form)
If you are a health care provider and want to expedite the delivery of a patient's medicine, please call 1-866-776-3700 and request an Expedited Product Order Form. This form is for the first supply only and exclusively covers the following medicines:

• Geodon^® (ziprasidone HCI)
• Inspra^® (eplerenone)
• Tikosyn^® (dofetilide)
• Zithromax^® (azithromycin)

For patients with hardship
Download Hardship Exception request form
If you have prescription coverage and are facing significant financial or medical hardship, you may be eligible to receive your medicine for free.

For those taking Lyrica^CV (pregabalin)
Download Lyrica application in English
Download Lyrica application in Spanish
If a patient has not already enrolled in Connection to Care, a New Patient Application must also be completed (see above)

For enrolled patients
Download Enrolled Patient Order Form in English (to reorder medicines)

Pfizer Pfriends® Pfizer Pfriends provides savings on 88 Pfizer medicines at participating pharmacies. The program helps qualified patients without prescription coverage, regardless of age or income.

Download English version
Download Spanish version