This site is intended only for residents of the United States and Puerto Rico.

GET HELP FILLING YOUR PRESCRIPTION FROM A PFIZER ACCESS & REIMBURSEMENT MANAGER (ARM)

A Pfizer ARM is:

  • A dedicated resource to provide support with accessing Oxbryta
  • A primary point of contact for you and your loved ones
Portrait of Jamie, an Access & Reimbursement Manager (ARM), standing at a desk smiling Portrait of Jamie, an Access & Reimbursement Manager (ARM), standing at a desk smiling

JAMIE

Access & Reimbursement Manager

Once support is requested, you will be assigned a Pfizer ARM who will:

Pink phone with blue signals icon

Give you a welcome call to discuss how they will support you

Pink phone with blue signal icon
Insurance card icon

Help you understand your and expected out-of-pocket costs, like copays

Pink phone with blue signal icon
Specialty pharmacy icon

Explain how to get your prescription from a Specialty Pharmacy

Pink phone with blue signal icon
Bell signals icon

Provide you and your loved ones with updates on your prescription plan, as well as notifications when it's time to complete an action step

Pink phone with blue signal icon
Nurse icon

Connect you with YourSource if you have questions about financial assistance or about how to enroll in the program for ongoing nurse support*

The YourSource Nurse Support Team does not replace the role of your healthcare provider. Please talk to your doctor if you need guidance about your specific condition or overall health.

REQUEST SUPPORT FROM A PFIZER ARM

Please read and make your selections below to indicate your consent.

PFIZER ARM SUPPORT OPT-IN

When you opt-in for Access & Reimbursement Manager (ARM) support you will be contacted by a Pfizer ARM who can help you understand your insurance benefits and navigate the process to access your prescribed medication. Pfizer ARMs are field-based employees of Pfizer Rare Disease and, if you choose, will help answer questions you may have about accessing the medication prescribed by your Healthcare Provider. Pfizer ARMs are familiar with access and reimbursement requirements, and the Pfizer ARM assigned to you serves as a resource for you on your journey to starting therapy. Working with a Pfizer ARM is optional. By checking this box/signing this form, I request Pfizer ARM support and agree to receive telephonic communications from the Pfizer ARM assigned to my case as described above. I understand that my consent is not required or a condition of purchasing any Pfizer goods or services. I understand that I can opt-out of support from and communications with the Pfizer ARM at any time by informing my assigned ARM that I no longer wish to communicate with them. I understand that this form will remain in effect for one year (ie, 1 year from the date of my signature) unless I opt-out of support from and communications with the Pfizer ARM at any time by informing my assigned ARM that I no longer wish to communicate with them.

Patient authorization date:

yyyy-MM-ddTHH:mm:ss

Patient Information

*All mandatory fields are marked with an asterisk.

Patient’s Caregiver Information

Healthcare Provider Information

*All mandatory fields are marked with an asterisk.

Pfizer Privacy Statement

Pfizer understands that your personal and health information is private and will only use your information in accordance with our Privacy Policy. The information you provide will only be used by Pfizer and parties acting on its behalf to send you the materials you requested as well as other helpful product and/or related product information, disease state information, offers, and services.

Pink x icon

THANK YOU!

Your request for support from a Pfizer Access & Reimbursement Manager (ARM) has been submitted. Expect a phone call from your Pfizer ARM soon!

GO TO YOURSOURCE SITE VISIT OXBRYTA SITE

ERROR!

Unsuccessful connection, please try again.

Blue signals icon
Pink phone with blue signals icon
CALL US FOR SUPPORT (833) 428-4968

The YourSource Team will be ready to help you once you've enrolled. | M-F, 8am-8pm ET

Close btn

Please confirm that you are a healthcare professional.

CONTINUE AND PROCEED GO BACK

Upwards arrow pink icon Upwards arrow pink icon Back
to top