Pfizer Dermatology Patient Access™ Interim Care Rx Program 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 CIBINQO® (abrocitinib) or LITFULO™ (ritlecitinib). 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, Michigan, Minnesota, or Rhode Island. Available up to a 30-day supply. Refills are subject to limitations. Interim Care offer does not require, nor will it 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 or appeals process. 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. Patients with insurance plans who carve out coverage for the product are not eligible to participate and/or continue participation in the Interim Care Program. Continued eligibility for the program requires submission by patient’s healthcare provider/patient of two appeals within the first 180 days of enrollment in the Interim Care Program (some exclusions apply). If at any time during the patient’s Interim Care Program enrollment there is a payer coverage change relating to the applicable product, Pfizer may conduct a new benefits investigation, and, if allowed by the payer, submission of a new Prior Authorization request and 2 appeals (if denied) must be submitted by patient’s healthcare provider/patient within 180 days of either, 1. the benefits investigation or 2. the date a new submission is allowed by the payer, for continued eligibility in the program. Assistance may be available for up to 2 years in total, which is the lifetime maximum per patient. If there is no payer coverage change, at 12 months of Interim Care Program enrollment, an updated prescription and benefits investigation is required to confirm continued eligibility. Additional eligibility criteria may apply. Contact Pfizer Dermatology Patient Access™ at 1-833-956-DERM (1-833-956-3376) for details.