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Pfizer enCompassCo-Pay AssistanceProgram Brochure forHealthcare Providers (HCPs) Please see full Prescribing Information for INFLECTRA, including BOXED WARNINGS and Medication Guide, also availableat InflectraHCP.com.Please see full Prescribing Information for RUXIENCE, including BOXED WARNINGS and Medication Guide, also available at RUXIENCEhcp.com.
Pfizer enCompass Co-Pay Assistance Program forINFLECTRA (infliximab-dyyb) for Injectionand RUXIENCE * (rituximab-pvvr)Program OverviewThe Pfizer enCompass Co-Pay Assistance Program provides eligible, commercially insuredpatients assistance of up to 20,000 for INFLECTRA and 25,000 for RUXIENCE percalendar year for claims received by the program. Eligible enrolled patients may pay aslittle as 0 for each INFLECTRA or RUXIENCE treatment. Federal and state healthcarebeneficiaries are not eligible. The co-pay program is for patients with private insuranceonly and covers only drug costs, not procedures, administration fees, or office visits. Seefull Terms and Conditions on page 8.This brochure provides an explanation of the enrollment process for the Pfizer enCompassCo-Pay Assistance Program, including specifics for when INFLECTRA or RUXIENCE areacquired through the buy-and-bill or specialty pharmacy process. An overview of theprocess includes:EnrollmentClaim SubmissionPayment*Pfizer enCompass supports patients prescribed INFLECTRA and RUXIENCE for select FDA-approved indications. For more information, visit www.pfizerencompass.com.Additional FDA-approved indications for RUXIENCE may be supported by Pfizer Oncology Together. For more information, visit www.pfizeroncologytogether.com.Please see full Prescribing Information for INFLECTRA, including BOXED WARNINGS and Medication Guide, also availableat InflectraHCP.com.Please see full Prescribing Information for RUXIENCE, including BOXED WARNINGS and Medication Guide, also available at RUXIENCEhcp.com.2
The Pfizer Co-Pay Portal You can find the Pfizer enCompass Co-Pay Assistance Program atwww.PfizerCopay.com. The co-pay portal allows HCPs to:- Register their practice- Enroll eligible patients- Submit claims- Select preferences, including payment method and address- View a patient’s status in the co-pay program as well as claim/payment statusand history The co-pay portal also allows patients to register and self-enroll if preferred For patients needing additional support, you may continue to enroll patients intoPfizer enCompass, where full patient support, including benefit verifications (BVs)and financial assistance, may be identifiedPlease see full Prescribing Information for INFLECTRA, including BOXED WARNINGS and Medication Guide, also availableat InflectraHCP.com.Please see full Prescribing Information for RUXIENCE, including BOXED WARNINGS and Medication Guide, also available at RUXIENCEhcp.com.3
EnrollmentThere are 2 ways to enroll your patients into the Pfizer enCompass Co-Pay AssistanceProgram after you register your site on www.PfizerCopay.com1. Enroll your patients into the co-pay program using the co-pay portal- This is best for patients who do not require additional patient support such as aBV or patient assistance- The co-pay card is activated in real time during enrollment2. Continue to enroll patients requiring additional support into Pfizer enCompass- Either fax or mail the completed enrollment form to Pfizer enCompass orcomplete the enrollment form on the provider portal atwww.pfizerencompassonline.com- Pfizer enCompass will follow up on missing information and complete a BV todetermine eligibility for the co-pay program. If approved, you and your patientreceive an approval letter containing co-pay card numbers- If you prefer a more self-service approach, log onto the provider portal tocomplete an eBVMeet the Smartcard The Pfizer enCompass Co-Pay Assistance Program includes a Smartcard option foryou to receive payment- If you are receiving payment via electronic funds transfer (EFT) or paper check,don’t worry; you can still receive payment that way The Smartcard may be used as both a debit and co-pay card-Your patients use this card to pay their co-pays to you usingthe debit card feature A co-pay claim must be submitted and approved prior to funds being loaded ontothe SmartcardPlease see full Prescribing Information for INFLECTRA, including BOXED WARNINGS and Medication Guide, also availableat InflectraHCP.com.Please see full Prescribing Information for RUXIENCE, including BOXED WARNINGS and Medication Guide, also available at RUXIENCEhcp.com.4
Claim SubmissionFor claims submitted to the Pfizer enCompass Co-Pay Assistance Program, make sure to: Submit claims within 180 days of each treatment date Include a copy of the Explanation of Benefits (EOB) document for the treatmentdate, which can be provided by your patient’s insurance companyThere are 3 ways to submit co-pay claims1. Submit claims directly at www.PfizerCopay.com2. Fax your claims to 877-847-FAX1 (877-847-3291)3. To mail claims, contact the Pfizer enCompass programPlease see full Prescribing Information for INFLECTRA, including BOXED WARNINGS and Medication Guide, also availableat InflectraHCP.com.Please see full Prescribing Information for RUXIENCE, including BOXED WARNINGS and Medication Guide, also available at RUXIENCEhcp.com.5
PaymentIf the HCP submitted a claim through the co-pay portal: If your patient has assigned co-pay benefits to you, you will indicate the preferredpayment method (EFT or check) in the co-pay portal at the time of claim submissionIf the patient submitted a claim:If your patient has already paid the co-payPayment will be a check that is mailed to themIf your patient has NOT already paid for the claimFunds will be loaded onto their SmartcardIf the specialty pharmacy submitted a claim: Pharmacies should submit both medical and pharmacy claims to the co-pay portaland, in either case, will receive payment via a bi-weekly checkPayment for fax or mail claims: Claims submitted by fax or mail follow the payment guidelines above but may takemore time for paymentPlease see full Prescribing Information for INFLECTRA, including BOXED WARNINGS and Medication Guide, also availableat InflectraHCP.com.Please see full Prescribing Information for RUXIENCE, including BOXED WARNINGS and Medication Guide, also available at RUXIENCEhcp.com.6
Pfizer enCompass SupportPfizer is committed to offering reimbursement and patient support for patients whohave been prescribed INFLECTRA or RUXIENCE. As part of this commitment, we havedeveloped Pfizer enCompass.Pfizer enCompass is available to provide:Reimbursement supporteBV is now available through the provider portalat www.pfizerencompassonline.comPatient support offered for eligible insured, uninsured, and underinsured PfizerenCompass patientsIf you have questions about the Pfizer enCompass Co-Pay Assistance Program orwould like to know more about other patient support options available through PfizerenCompass, please contact a Pfizer enCompass Access Counselor or visitwww.pfizerencompass.com for more information.Updated brochures that explain the program details and revised claim and enrollmentforms are available on www.pfizerencompass.com. Reimbursement and patient supportinformation is also available at www.pfizerencompass.com.In addition, your Field Reimbursement Manager is available to answer questions aboutthe enhanced Pfizer enCompass Co-Pay Assistance Program.If you have questions or would like to know more abouteligibility requirements for available patient assistance options,please call Pfizer enCompass to speak to an Access Counselor at1-844-722-6672 or visit www.pfizerencompassonline.com.Please see full Prescribing Information for INFLECTRA, including BOXED WARNINGS and Medication Guide, also availableat InflectraHCP.com.Please see full Prescribing Information for RUXIENCE, including BOXED WARNINGS and Medication Guide, also available at RUXIENCEhcp.com.7
Terms and Conditions: By using this program, you acknowledge that you currently meetthe eligibility criteria and will comply with the terms and conditions below:The Pfizer enCompass Co-Pay Assistance Program for INFLECTRA and RUXIENCE is not valid forpatients that are enrolled in a state or federally funded insurance program, including but not limited toMedicare, Medicaid, TRICARE, Veterans Affairs health care, a state prescription drug assistance program,or the Government Health Insurance Plan available in Puerto Rico (formerly known as “La Reforma deSalud”). Program offer is not valid for cash-paying patients. Patients prescribed RUXIENCE for pemphigusvulgaris are not eligible for this co-pay savings program. With this program, eligible patients may payas little as 0 co-pay per INFLECTRA or RUXIENCE treatment. There are specific maximum annualpatient savings for each product, which range from 20,000 (INFLECTRA) to 25,000 (RUXIENCE)for out-of-pocket expenses for the respective product including co-pays or coinsurances. The amountof any benefit is the difference between your co-pay and 0. After the maximum benefit, you will beresponsible for the remaining monthly out-of-pocket costs. Patient must have private insurance withcoverage of INFLECTRA or RUXIENCE. This offer is not valid when the entire cost of your prescriptiondrug is eligible to be reimbursed by your private insurance plans or other private health or pharmacybenefit programs. You must deduct the value of this assistance from any reimbursement requestsubmitted to your private insurance plan, either directly by you or on your behalf. You are responsiblefor reporting use of the program to any private insurer, health plan, or other third party who pays for orreimburses any part of the prescription filled using the program, as may be required. You should not usethe program if your insurer or health plan prohibits use of manufacturer co-pay assistance programs.This program is not valid where prohibited by law. This program cannot be combined with any othersavings, free trial or similar offer for the specified prescription. Co-pay card will be accepted only atparticipating pharmacies. This program is not health insurance. This program is good only inthe U.S. and Puerto Rico. This program is limited to 1 per person during this offering period and is nottransferable. No other purchase is necessary. Data related to your redemption of the program assistancemay be collected, analyzed, and shared with Pfizer, for market research and other purposes relatedto assessing Pfizer’s programs. Data shared with Pfizer will be aggregated and de-identified; it will becombined with data related to other assistance redemptions and will not identify you. Pfizer reservesthe right to rescind, revoke or amend this program without notice. This program may not be availableto patients in all states. For more information about Pfizer, visit www.pfizer.com. For more informationabout the Pfizer enCompass Co-Pay Assistance Program, call Pfizer enCompass at 1-844-722-6672, orwrite to Pfizer enCompass Co-Pay Assistance Program, P.O. Box 220040, Charlotte, NC 28222. Programterms and offer will expire at the end of each calendar year. Before the calendar year ends, you willreceive information and eligibility requirements for continued participation. Please see full Prescribing Information for INFLECTRA, including BOXED WARNINGS and Medication Guide, also availableat InflectraHCP.com.Please see full Prescribing Information for RUXIENCE, including BOXED WARNINGS and Medication Guide, also available at RUXIENCEhcp.com.8PP-RIT-USA-0361 2022 Pfizer Inc.All rights reserved.February 2022
about the Pfizer enCompass Co-Pay Assistance Program, call Pfizer enCompass at 1-844-722-6672, or write to Pfizer enCompass Co-Pay Assistance Program, P.O. Box 220040, Charlotte, NC 28222. Program terms and offer will expire at the end of each calendar year. Before the calendar year ends, you will
