This site is intended only for healthcare professionals.

Pfizer Dermatology Patient Access™ enrollment form
Pfizer Dermatology Patient Access Enrollment Form

The enrollment form may be downloaded, completed, and returned by fax or mail.

ENROLLMENT FORM

You can also enroll your patients online. Find out more.

Pfizer Dermatology Patient Access™ prior authorization checklist
CIBINQO Prior Authorization and Appeals Checklist

Checklist for atopic dermatitis that helps you and your office staff assemble the information needed by insurers.

CIBINQO PA AND APPEALS CHECKLIST
Pfizer Dermatology Patient Access™ prior authorization checklist
LITFULO Prior Authorization and Appeals Checklist

Checklist for alopecia areata that helps you and your office staff assemble the information needed by insurers.

LITFULO PA AND APPEALS CHECKLIST
Pfizer Dermatology Patient Access™ appeals checklist Pfizer Dermatology Patient Access™ sample letter of medical necessity
Sample Letters

These materials can be used to help support your patients during the prior authorization and appeals processes.

The Sample Letter of Medical Necessity is for you to complete on your patient's behalf during the prescription journey.

The Sample Patient Narrative Letter is completed by the patient with alopecia areata and shares their personal diagnosis story with insurance companies.

SAMPLE LETTER OF MEDICAL NECESSITY SAMPLE PATIENT NARRATIVE LETTER
Pfizer Patient Assistance Program application
Pfizer Patient Assistance Program Application

The Pfizer Patient Assistance Program may provide free medication for eligible patients.

PFIZER PATIENT ASSISTANCE PROGRAM APPLICATION
Access and Affordability Resource Guide
HCP Access Brochure

An overview of patient access for Pfizer dermatology medications.

HCP ACCESS BROCHURE
Pfizer Dermatology Patient Access™ HCP Portal Guide
HCP Portal Guides

Reference guides help you and your office staff get familiar with the Pfizer Dermatology HCP Portal.

QUICK REFERENCE COMPREHENSIVE USER GUIDE
Pfizer Dermatology Patient Access™ HCP Portal Guide
Patient Access Coordinator Flashcard

An overview of the support your patients receive when opting in to Patient Access Coordinator support.

PATIENT ACCESS COORDINATOR FLASHCARD
Pfizer Dermatology Patient Access™ HCP Portal Guide
Getting Started on a Specialty Medication

A resource for patients outlining what they can expect when getting started on a specialty medication.

GETTING STARTED ON A SPECIALTY MEDICATION
Pfizer Dermatology Patient Access™ HCP Portal Guide
Biologic Coordinator Patient Journey Map and Checklist

A resource to support patients navigating commercial insurance on their prescription fulfillment journey.

BIOLOGIC COORDINATOR PATIENT JOURNEY MAP AND CHECKLIST
Pfizer Dermatology Patient Access™ HCP Portal Guide
Voucher Request Form

For patients NEW to CIBINQO, a voucher to order a one-time, 30-day trial supply of CIBINQO.

VOUCHER REQUEST FORM
Pfizer Dermatology Patient Access™ HCP Portal Guide
eRx IC/Voucher Request Form

An Interim Care and Voucher request form for patients enrolled in PDPA.

eRx IC/VOUCHER REQUEST FORM
Pfizer Dermatology Patient Access™ HCP Portal Guide
ePA Reference Guide

A quick reference guide to electronically complete the prior authorization process for patients enrolled in PDPA.

ePA REFERENCE GUIDE
Pfizer Dermatology Patient Access™ HCP Portal Guide
Specialty Pharmacy Flashcard

Defines the overall post-Rx journey and provides information regarding the specialty pharmacies included in the defined distribution network.

SPECIALTY PHARMACY FLASHCARD