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X 1-888-773-0121 PO Box 220574 Charlotte, NC 28222-0574 Please check the appropriate Pfizer product (For full prescribing information, go to www.pfizer.com) ( mesylate) ( mesylate) () () () (silendafil citrate) Has the Tropism assay been completed? Patient Name: Sex: Yes Male No Female Patient Address: City: Telephone (Day): ( ).

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Savings (available through the Rexulti Savings Card): Eligible commercially insured patients pay as little as $0 per 30-day supply and save up to $100 per fill; valid for 12 prescriptions per year; for additional information contact the program at 844-415-0674.

The Medication Assistance program provides resources to help those who do not have health insurance and limited or no prescription coverage obtain their prescription medication for free or almost free.

Novartis Patient Assistance Foundation provides medicines at no cost to eligible US patients who are experiencing financial hardship.

Fax or mail your completed application to: Fax: 1-(855)-817-2711 —OR— Mail: NPAF, P.O. Box 52029, Phoenix, AZ 85072-2029 .PAP.Novartis.com Phone: 1-(800)-277-2254 Fax: 1-(855)-817-2711 P.O. Box 52029, Phoenix, AZ 85072-2029 Monday-Friday 8:00 a.m. to 8:00 p.m. Eastern Time Zone Page 2 PLEASE KEEP THIS PAGE FOR YOUR ...

Novartis Patient Support Patient Navigators are dedicated to supporting healthcare providers and patients throughout the reimbursement journey by providing ongoing education, support, solutions, and dedicated resources to help limit barriers that may hinder access to appropriate medications.

Patient assistance programs (PAPs) are usually sponsored by pharmaceutical manufacturers and are promoted as a safety net for Americans who have no health insurance or are underinsured. The goal of these programs is to provide financial assistance to help these patients access medications for little or no cost.

With the Savings Card, you may pay as little as $4 for each 30-day fill of brand-name . Eligible patients could save up to $1,800 a year. Savings Card only works on brand-name . Terms and Conditions apply.

The ® Patient Assistance Program provides assistance to patients experiencing financial hardship who have no third-party insurance coverage for their medicines. Patient must be a U.S. Resident. Patient must not have prescription drug coverage (public or private). Patient must meet income eligibility criteria.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232