a patient’s guide to pfizer encompass™ support … encompass™ offers a variety of...

INFLECTRA is a registered trademark of Hospira UK, a Pfizer company.Pfizer enCompass is a trademark of Pfizer Inc.

A Patient’s Guide

to Pfizer enCompass™ Support Programs

for INFLECTRA®

Please see Important Safety Information and Indications on pages 9-11, full Prescribing Information, including BOXED WARNING and Medication Guide, available at InflectraHCP.com.

http://labeling.pfizer.com/ShowLabeling.aspx?id=9271

http://labeling.pfizer.com/ShowLabeling.aspx?id=9271#page=57

https://www.pfizerpro.com/product/inflectra/hcp

CommerciallyInsured

Publicly Insured

(eg, Medicare, Medicaid)

Uninsured

Benefit Verification X X

Prior Authorization Assistance X X

Appeals Assistance* X X

Interim Assistance X

Alternate Funding Research† X X X

Patient Reimbursement Support Services

*For patients diagnosed with an FDA-approved indication for INFLECTRA.†If assistance is requested.

Commercially Insured

Publicly Insured

(eg, Medicare, Medicaid)

Uninsured

Co-Pay Program* X

Patient Assistance Program* X X X

Drug Replacement Program* X X

Patient Financial Support Services

*For eligible patients only.

Pfizer enCompass™ offers a variety of reimbursement and patient financial support services for patients needing therapy with INFLECTRA. Pfizer enCompass offers the following reimbursement and patient support services:

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Pfizer enCompass helps eligible patients get access to INFLECTRA therapy. Pfizer enCompass offers various services to patients including reimbursement support for insured patients; co-pay assistance for eligible commercially insured patients who cannot afford their co-pays, co-insurances, or deductibles; and a free medicine patient assistance program for eligible uninsured or underinsured patients.

This guide has been prepared to provide you with information describing the patient support options offered through Pfizer enCompass, including:

Pfizer enCompass has Access Counselors available to help you determine which services can help you. To see if Pfizer enCompass can help you, you will need to work with your doctor to complete the appropriate enrollment forms. If you have questions, or would like to know more about Pfizer enCompass, please call Pfizer enCompass to speak to an Access Counselor.

• Call 1-844-722-6672, Monday–Friday, 9 am–8 pm ET

• Visit www.pfizerinflectra.com

• A summary of how the program works

• Pfizer Patient Assistance Program for Pfizer enCompass patients

• Pfizer enCompass Co-Pay Assistance Program

• Reimbursement Support Services

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Introduction

How the Program Works





Pfizer offers 2 programs that can provide financial assistance to help you get access to the treatments you need.

The Pfizer enCompass Co-Pay Assistance Program provides assistance for out-of-pocket drug costs associated with INFLECTRA due to co-pays, co-insurances, or deductibles, up to $20,000 per calendar year. You are responsible for the first $5 of each injection before the benefit may be used. It does not cover or provide support for supplies, services, or procedures associated with INFLECTRA. Please see full terms and conditions at the end of this guide.

Assignment of Benefits If you are enrolled in the Pfizer enCompass Co-Pay Assistance Program, you have the option to assign benefits to your healthcare provider, which means your healthcare provider will receive reimbursement directly from the co-pay program.

Claim Submission If your healthcare provider does not submit your claim, or if a pharmacy dispensed the prescription, you may submit a claim to the program. To request a claim form, please contact an Access Counselor at the Pfizer enCompass Co-Pay Assistance Program.

The Pfizer enCompass Co-Pay Assistance Program can assist private/commercially insured patients (eg, insurance provided through your employer or insurance plans purchased through state exchanges) with out-of-pocket drug costs associated with INFLECTRA treatment such as co-pays, co-insurances, or deductibles.

The Pfizer Patient Assistance Program for Pfizer enCompass patients provides INFLECTRA free of charge to eligible uninsured or underinsured patients.

Pfizer enCompass Co-Pay Assistance Program

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Patient Financial Support Services





Pfizer Patient Assistance Program* for Pfizer enCompass Patientss This program provides INFLECTRA free of charge to eligible patients who:

• Do not have insurance

• Have insurance that denies coverage of INFLECTRA

• Are underinsured (ie, have insurance but are struggling to pay their share of treatment costs, and other coverage options are not available)

You and your doctor will need to complete an application form to determine if you are eligible for help. To be eligible for the Patient Assistance Program, you must:

• Live in the United States (or US territories) and be under the care of a licensed healthcare provider

• Be treated in the outpatient setting like a doctor’s office

• Meet income criteria and provide proof of income

• Not be eligible (or have been denied) for any available alternate coverage options

Uninsured patients who are approved for patient assistance will be enrolled for 12 months. Underinsured patients who are approved will be enrolled through the end of a calendar year. You can re-apply if you still need assistance at the end of the enrollment period.

If Pfizer enCompass identifies an alternate source of coverage and you are receiving free product from the Patient Assistance Program, Pfizer enCompass will transition you to the alternate coverage source upon confirmation. You may continue receiving free product until your actual coverage begins.

*The Pfizer Patient Assistance Program is a joint program of Pfizer Inc and the Pfizer Patient Assistance Foundation. The Pfizer Patient Assistance Foundation is a separate legal entity from Pfizer Inc with distinct legal restrictions.

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If you have insurance and are concerned about INFLECTRA reimbursement, you can apply for the DRP before starting treatment. If you are eligible, the DRP will work with your doctor to replace the INFLECTRA used if your insurance does not cover your treatment.

You and your healthcare providers will need to complete the application form to determine if you are eligible for the DRP. You must submit the application prior to beginning treatment. To be eligible for DRP, you must:

• Live in the United States (or US territories) and be under the care of a licensed healthcare provider

• Be treated in the outpatient setting like a doctor’s office

• Meet income criteria and provide proof of income

• Have insurance coverage for INFLECTRA

ProcessFlow

Your doctor prescribes INFLECTRA

You and your doctor enroll into Pfizer enCompass by completing the Pfizer enCompass enrollment form

A Pfizer enCompass Access Counselor researches your health insurance benefits to understand your coverage for INFLECTRA

If you are in need of assistance with out-of-pocket expenses for INFLECTRA, you will be referred to financial assistance programs

If you do not have health insurance or have been denied coverage for INFLECTRA, you and your doctor will submit a Pfizer Patient Assistance Program application to see if you are eligible for free INFLECTRA

You and your doctor schedule your treatment with INFLECTRA

You receive your infusion of INFLECTRA

Your healthcare provider submits on your behalf, or assists you with submitting a claim for your out-of-pocket costs for INFLECTRA, if you are enrolled in the Pfizer enCompass Co-Pay Assistance Program

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Drug Replacement Program (DRP) for Pfizer enCompass Patients

Program Summary and Process Flow





A Pfizer enCompass Access Counselor will help you understand how your insurance may cover INFLECTRA.

Benefit VerificationAccess Counselors will research your insurance benefits to explain coverage options and requirements, and your costs for INFLECTRA.

Prior Authorization Support and Appeals AssistancePfizer enCompass will work with your doctor’s office on your behalf when your insurance requires prior authorization for INFLECTRA. We will follow up with your insurance until they make a decision on your prior authorization request.

Appeals AssistanceWhere appropriate, Access Counselors can work with your doctor’s office on your behalf to understand why your insurance has denied coverage for INFLECTRA, and determine if and how an appeal may be filed by your doctor. Access Counselors will follow up on the status of an appeal until your insurance makes their decision.

Interim AssistancePatients with commercial insurance who meet one of the following criteria may be eligible to receive up to a 3-month supply of INFLECTRA:

• Your insurance company is experiencing a delay in recognizing INFLECTRA or delays covering INFLECTRA

• INFLECTRA is covered under a pharmacy benefit and you are experiencing delays in access

Alternate Funding ResearchAccess Counselors will research if other sources of coverage or financial assistance are available for you. If the Access Counselor identifies an alternate coverage source, the Access Counselor will assist you with the application process. Access Counselors will also follow up with you regarding enrollment status for alternate coverage sources until the source provides a determination.

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Reimbursement Support Services





Terms and Conditions: The Pfizer enCompass™ Co-Pay Assistance Program for INFLECTRA® is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, Tricare or other federal or state healthcare programs (including any state prescription drug assistance programs) and the Government Health Insurance Plan available in Puerto Rico (formerly known as “La Reforma de Salud”). This program is not health insurance. No membership fees. The Pfizer enCompass Co-Pay Assistance Program reimbursement is limited to $20,000 per year for out-of-pocket expenses for INFLECTRA including co-pays, coinsurances, or deductibles. Patients are responsible for the first $5 for each INFLECTRA treatment before this benefit can be used. No claim for reimbursement of the out-of-pocket expense amount covered by this program shall be submitted to any third-party payer, whether public or private. This offer is not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private insurance plans or other health or pharmacy benefit programs. This offer cannot be combined with any other rebate/coupon, free trial or similar offer for the specified prescription. This offer is limited to 1 per person during this offering period and is not transferable. Offer good only in the United States and Puerto Rico. Certain restrictions may apply. Offer may not be available to patients in all states. This offer is not valid where prohibited by law, taxed, or restricted. Pfizer reserves the right to rescind, revoke or amend this offer without notice. By using this program, you understand and agree to comply with the terms and conditions as set forth above. For more information about Pfizer, visit www.pfizer.com. For more information 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.

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Only your doctor can recommend a course of treatment after checking your health condition. INFLECTRA® (infliximab-dyyb) can cause serious side effects such as lowering your ability to fight infections. Some patients, especially those 65 years and older, have had serious infections caused by viruses, fungi or bacteria that have spread throughout the body, including tuberculosis (TB) and histoplasmosis. Some of these infections have been fatal. Your doctor should monitor you closely for signs and symptoms of TB during treatment with INFLECTRA®.

Unusual cancers have been reported in children and teenage patients taking TNF-blockermedicines. Hepatosplenic T-cell lymphoma, a rare form of fatal lymphoma, has occurredmostly in teenage or young adult males with Crohn’s disease or ulcerative colitis who weretaking infliximab products and azathioprine or 6-mercaptopurine. For children and adultstaking TNF blockers, including INFLECTRA®, the chances of getting lymphoma or other cancers may increase.

You should discuss any concerns about your health and medical care with your doctor.

What should I tell my doctor before I take INFLECTRA®? You should let your doctor know if you have or ever had any of the following:

• Tuberculosis (TB) or have been near someone who has TB. Your doctor will check you for TB with a skin test. If you have latent (inactive) TB, you will begin TB treatment before you start INFLECTRA®.

• Lived in a region where certain fungal infections like histoplasmosis or coccidioidomycosis are common.

• Infections that keep coming back, diabetes, or an immune system problem.

• Any type of cancer or a risk factor for developing cancer, for example, chronic obstructive pulmonary disease (COPD) or had phototherapy for psoriasis.

• Heart failure or any heart condition. Many people with heart failure should not take INFLECTRA®.

• Hepatitis B virus (HBV) infection or think you may be a carrier of HBV. Your doctor will test you for HBV.

• Nervous system disorders (like multiple sclerosis or Guillain-Barré syndrome).

Also tell your doctor if you:

• Use the medicines Kineret (anakinra), Orencia (abatacept), or Actemra (tocilizumab) or other medicines called biologics used to treat the same problems as INFLECTRA®.

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Continued on the next page

IMPORTANT SAFETY INFORMATION AND INDICATIONS

Please see full Prescribing Information, including BOXED WARNING and Medication Guide, available at InflectraHCP.com.




• Are pregnant, plan to become pregnant, are breast-feeding, or have a baby and were using INFLECTRA® during your pregnancy. Tell your baby’s doctor about your INFLECTRA® use. If your baby receives a live vaccine within 6 months after birth, your baby may develop infections with serious complications that can lead to death.

• Recently received or are scheduled to receive a vaccine. Adults and children taking INFLECTRA® should not receive live vaccines or treatment with a weakened bacteria (such as BCG for bladder cancer) while taking INFLECTRA®.

What should I watch for and talk to my doctor about before or while taking INFLECTRA®?

The following serious (sometimes fatal) side effects have been reported in people taking INFLECTRA®.

You should tell your doctor right away if you have any of the signs listed below:

• Infections (like TB, blood infections, pneumonia)—fever, tiredness, cough, flu, or warm, red, or painful skin, or any open sores. INFLECTRA® can make you more likely to get an infection or make any infection that you have worse.

• Lymphoma or any other cancers in adults and children.

• Skin cancer—any changes in or growths on your skin.

• Heart failure—new or worsening symptoms, such as shortness of breath, swelling of your ankles or feet, or sudden weight gain.

• Reactivation of HBV—feeling unwell, poor appetite, tiredness, fever, skin rash, and/or joint pain.

• Liver injury—jaundice (yellow skin and eyes), dark brown urine, right-sided abdominal pain, fever, or severe tiredness.

• Blood disorders—fever that doesn’t go away, bruising, bleeding, or severe paleness.

• Nervous system disorders—numbness, weakness, tingling, changes in your vision, or seizures.

• Allergic reactions during or after the infusion—hives, difficulty breathing, chest pain, high or low blood pressure, swelling of face and hands, and fever or chills.

• Lupus-like syndrome—chest discomfort or pain that does not go away, shortness of breath, joint pain, rash on the cheeks or arms that gets worse in the sun.

• Psoriasis—new or worsening psoriasis such as red scaly patches or raised bumps on the skin that are filled with pus.

Continued on the next page

IMPORTANT SAFETY INFORMATION AND INDICATIONS (Continued)

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The more common side effects with infliximab products are respiratory infections (that may include sinus infections and sore throat), headache, rash, coughing, and stomach pain.

INFLECTRA® is a prescription medication used to treat:

Crohn’s Disease

• Can reduce signs and symptoms and induce and maintain remission in adult patients with moderately to severely active Crohn’s disease who haven’t responded well to other therapies

Pediatric Crohn’s Disease

• Can reduce signs and symptoms and induce and maintain remission in children (ages 6-17) with moderately to severely active Crohn’s disease who haven’t responded well to other therapies

Ulcerative Colitis

• Can reduce signs and symptoms, induce and maintain remission, promote intestinal healing, and reduce or stop the need for steroids in adult patients with moderately to severely active ulcerative colitis who haven’t responded well to other therapies

Rheumatoid Arthritis

• Can reduce signs and symptoms, help stop further joint damage, and improve physical function in patients with moderately to severely active rheumatoid arthritis, in combination with methotrexate

Ankylosing Spondylitis

• Can reduce signs and symptoms in patients with active ankylosing spondylitis

Psoriatic Arthritis

• Can reduce signs and symptoms of active arthritis, help stop further joint damage, and improve physical function in patients with psoriatic arthritis

Plaque Psoriasis

• Approved for the treatment of adult patients with chronic severe (extensive and/or disabling) plaque psoriasis under the care of a physician who will determine if INFLECTRA® is appropriate considering other available therapies

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PP-IFA-USA-0201 © 2017 Pfizer Inc. All rights reserved. September 2017

IMPORTANT SAFETY INFORMATION AND INDICATIONS (Continued)





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