Pfizer Hemophilia Connect

When HYMPAVZI is prescribed by your doctor, Pfizer may provide you with information about insurance coverage and reimbursement support, as well as educational resources to help along the treatment journey.

Call Pfizer Hemophilia Connect at 1-888-733-2030 to enroll, Monday-Friday from 8:00 AM to 6:00 PM EST, or speak to your healthcare provider to enroll you.

*FULL CO-PAY SAVINGS PROGRAM TERMS AND CONDITIONS

By using this co-pay card, you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions described below:
Eligible patients with commercial prescription drug insurance coverage for HYMPAVZI^® may pay as little as $0 per prescription fill. Patient out of pocket expense will vary. The value of this offer is limited to annual benefit of up to $15,000. Once a patient reaches the annual maximum benefit patient is responsible for paying the remaining monthly out-of-pocket costs. Patients are not eligible to use this card if they are enrolled in a state or federally funded insurance program, including but not limited to Medicare, 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 de Salud”). Patient must have private insurance with coverage. Offer is not valid for cash paying patients. This offer is not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private insurance plan or other private health or pharmacy benefit programs. You must deduct the value of this co-pay card from any reimbursement request submitted to your private insurance plan, either directly by you or on your behalf. You are responsible for reporting use of the co-pay card to any private insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the co-pay card, as may be required. You should not use the co-pay card if your insurer or health plan prohibits use of manufacturer co-pay cards. This co-pay card is not valid for Massachusetts residents whose prescriptions are covered in whole or in part by third party insurance. This co-pay card is not valid where prohibited by law. The benefit under the co-pay card program is offered to, and intended for the sole benefit of, eligible patients and may not be transferred to or utilized for the benefit of third parties, including, without limitation, third party payers, pharmacy benefit managers, or the agents of either. Third party payers, pharmacy benefit managers, or the agents of either, are prohibited from assisting patients with enrolling in the co-pay card program. Co-pay card cannot be combined with any other external savings, free trial, or similar offer for the specified prescription (including any program offered by a third-party payer or pharmacy benefit manager, or an agent of either, that adjusts patient cost sharing obligations, through arrangements that may be referred to as “accumulator” or “maximizer” programs). Some health insurers or pharmacy benefit managers (or their agents) may have established accumulator adjustment or co-pay maximizer programs based on the availability of support under the offer co-pay program and/or exclude the financial assistance provided under the offer co-pay program from counting towards patient deductibles or out-of-pocket cost limitations. Co-pay card will be accepted only at participating pharmacies. If your pharmacy does not participate, you may be able to submit a request for a rebate in connection with this offer. This co-pay is not health insurance. Offer good only in the U.S. and Puerto Rico. Co-pay card is limited to 1 per person during this offering period and is not transferable. A co-pay card may not be redeemed more than once per 28 days per patient. No other purchase is necessary. Data related to your redemption of the co-pay card may be collected, analyzed, and shared with Pfizer, for market research and other purposes related to assessing Pfizer’s programs. Data shared with Pfizer will be aggregated and de-identified; it will be combined with data related to other co-pay card redemptions and will not identify you. Pfizer reserves the right to rescind, revoke or amend this offer without notice. Offer expires 12/31/2026. For questions regarding the offer, please call (1-888-733-2030), visit www.HYMPAVZI.com or write Pfizer Hemophilia Connect, 600 Emerson Road, 3rd Floor, Suite 300, Creve Coeur, MO 63141

^†HYMPAVZI VOUCHER TERMS & CONDITIONS

By redeeming this voucher, you acknowledge that you currently meet the eligibility criteria and will comply with the Terms & Conditions described below:

• You will receive a one-time, 28-day supply of HYMPAVZI. Only eligible new HYMPAVZI patients may use this voucher, and each patient is limited to 1 voucher.
• By redeeming this voucher, you certify that you are not currently using HYMPAVZI.
• An original voucher and a valid prescription must be presented to the pharmacy.
• The voucher will be accepted only at participating pharmacies.
• You must not submit any claim for reimbursement for product dispensed pursuant to this voucher to any third-party payor, including Medicare, Medicaid, or any other federal or state health care program. You cannot apply the value of the free product received through this voucher toward any government insurance benefit out-of-pocket spending calculations, such as Medicare Part D True Out-of-Pocket Costs (TrOOP).
• You must be 18 years of age or older or be 18 years of age or older and a caregiver of a HYMPAVZI patient.
• This voucher is not valid where prohibited by law.
• This voucher cannot be combined with any other savings, free trial, or similar offers for the specified prescription.
• This free trial voucher is not health insurance. This free trial voucher may not be used to address delays or gaps in health insurance coverage for the specified prescription.
• Offer good only in the U.S. and Puerto Rico.
• No purchase is necessary.
• Patients have no obligation to continue to use HYMPAVZI.
• Pfizer reserves the right to rescind, revoke, or amend this offer without notice. This voucher expires on 12/31/2026.

Massachusetts residents may select their pharmacy. Otherwise, this free trial will be supplied through SONEXUS.

^‡FULL INTERIM CARE RX TERMS AND CONDITIONS

Interim Care is not health insurance and is available for eligible, commercially insured patients only. Offer is only available to patients who have been diagnosed with an FDA-approved indication for HYMPAVZI^® (marstacimab-hncq). The Interim Care Program is applicable to all HYMPAVZI^® formulations. No claim for reimbursement for product dispensed pursuant to this offer may be submitted to any third-party payer. Not available to patients covered under Medicaid, Medicare or other federal or state healthcare programs, including any state prescription drug assistance programs and the Government Health Insurance Plan or for residents of Massachusetts or Michigan. For residents of Minnesota or Rhode Island, available for up to six months. For all other eligible patients, this program is available for a period of up to twelve months (lifetime maximum) or until they receive insurance coverage approval, whichever occurs earlier. Available in 30-day supply. Refills are subject to limitations. Continued eligibility for the program requires, 1. submission of first appeal within 60 days of enrollment (or within the required payer timeline, if sooner) in the Interim Care Program and submission of the second appeal, if allowed by the payer, within 60 days of the date of the first appeal denial (or within the required payer timeline, if sooner), 2. satisfying all payer appeal requirements and 3. patients schedule their initial prescription dispense within 60 days of enrollment. Pfizer may conduct periodic benefits investigation to determine if there is a payer coverage change. If payer coverage is identified and allowed by the payer, Pfizer may require submission, of a new Prior Authorization request and appeal, if denied, within 60 days (or within the required payer timeline, if sooner) of either, 1. the date of completion of the benefits investigation, provided by the Pfizer Hemophilia Connect Program to the patient’s authorized healthcare provider, or 2. the date a new submission is allowed by the payer, for continued eligibility in the program, whichever is later. Interim Care offer does not require, nor will be made contingent on, purchase requirements of any kind. Pfizer reserves the right to amend, rescind, or discontinue this program at any time without notification. Interim Care can only be dispensed by the exclusive pharmacy and only after a benefits investigation has been completed and a delay occurs in the Prior Authorization process, or an appeal is required. All payer appeal timelines must be met for continued assistance. Offer good only in the U.S. and Puerto Rico. Prescription must be provided by a healthcare provider licensed in the U.S. or Puerto Rico. Additional eligibility criteria may apply. Contact Pfizer Hemophilia Connect at 1-888-733-2030 for details.