*Required
I am Taking ELREXFIO
I am caring for someone taking ELREXFIO
Patient/Caregiver consent* By checking this box, I request Pfizer Patient Access Navigator support and agree to receive telephonic communications from the Pfizer Patient Access Navigator 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 can opt out of support from and communications with the Patient Access Navigator at any time by informing my assigned Patient Access Navigator that I no longer wish to communicate with them. Review additional terms.
Pfizer Privacy Policy: 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.
This form may take a few moments to submit. Please wait until you receive confirmation.
When you opt in for Pfizer Patient Access Navigator support, you will be contacted by a Pfizer Navigator who can help you understand your insurance benefits and navigate the process to access your prescribed medicine. Patient Access Navigators are field-based employees of Pfizer Oncology Together and, if you choose, will help answer questions you may have about accessing the medicine prescribed by your healthcare provider. Navigators are very familiar with access and reimbursement requirements for ELREXFIO, and the Navigator assigned to you serves as a resource for you on your journey to starting therapy. Working with a Navigator is optional. By checking this box/signing this form, you request Patient Access Navigator support and agree to receive telephonic communications from the Navigator assigned to your case as described above. You understand that your consent is not required or a condition of purchasing any Pfizer goods or services.
Close
Please see ELREXFIO Medication Guide and full Prescribing Information, including BOXED WARNING, or visit ELREXFIO.com.
Looking for help? Call 1-877-744-5675 Monday–Friday 8 AM–8 PM ET)
