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As part of its commitment to patients with CIDP, Pfizer is proud to offer the Pfizer Pledge Warranty Program*† for adult patients with CIDP starting PANZYGA. With this program, eligible patients can get their out-of-pocket drug costs for PANZYGA refunded. See below to learn more.
Pfizer, Inc. (referred to as “us,“ “we” and similar terms) is proud to offer the Pfizer Pledge Warranty Program for PANZYGA (the “Program“) to each Patient (referred to as “you,“ “your“ and similar terms) who meets the Eligibility Requirements and follows the Program Procedures described below, subject to all the terms and conditions in this document (the “Terms“). You should carefully review these Terms.
Overview of Program
For Patients who meet the Eligibility Requirements, Pfizer will refund the out-of-pocket amount that you paid for up to the first 4 Treatments of PANZYGA for the chronic inflammatory demyelinating polyneuropathy (CIDP) indication, up to a maximum of $16,500 per treatment. The total, per patient, Program refund shall not exceed $50,000 (the “Maximum”). Treatment is defined as the total prescribed dose, which may be administered by a healthcare provider over one or more days. If your commercial insurance and/or other payers (“Your Plan(s)”) paid for all or a portion of the cost of PANZYGA, Pfizer will, on your behalf, refund Your Plan(s) the Average Sales Price as calculated by Pfizer up to the Maximum, less documented out-of-pocket payments provided by you or on your behalf. Payments to all parties must be equal to or less than the cost paid by each party and may reset Your Plan(s)’s out-of-pocket deductible cost in accordance with Your Plan(s)’s benefit design. The order of priority of Warranty payments is first to you and then to Your Plan that is primary and then to Your Plan(s) that are secondary as determined by information provided by you and the documented proof of payment that you provide to us. You are responsible for submitting proof of payment for you and for Your Plan(s). All claims payments will be reported to Your Plan(s).
Medication Eligible for the Program
PANZYGA [Immune Globulin Intravenous (Human) - ifas]
The Pfizer Pledge Warranty Program is available to adult, cash-paying or commercially insured patients. Patients are not eligible for the program if their PANZYGA was covered, in whole or in part, by Medicare, Medicaid, TRICARE, Veterans Affairs health care, a state prescription drug assistance program, or the Government Health Insurance Plan available in Puerto Rico. Commercially insured or cash-paying adult patients must satisfy all of the following criteria in order to be eligible to use the Program:
Costs other than for the drug will not be reimbursed (i.e., administration costs).
You must submit all Claims Information (as described below) within 180 days following the administration date of your last treatment of PANZYGA.
Benefit Request Process
LIMITATION OF LIABILITY
IN NO EVENT, UNDER ANY CAUSE OF ACTION OR THEORY OF LIABILITY, SHALL PFIZER, ITS DISTRIBUTORS OR SUPPLIERS BE LIABLE TO YOU OR ANY THIRD PARTY FOR ANY INDIRECT, INCIDENTAL, CONSEQUENTIAL, SPECIAL, EXEMPLARY, OR PUNITIVE DAMAGES, OF ANY NATURE WHATSOEVER, ARISING OUT OF OR IN CONNECTION WITH THE PROGRAM, EVEN IF PFIZER HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.
NOTWITHSTANDING ANY DAMAGES THAT YOU MIGHT INCUR FOR ANY REASON WHATSOEVER, INCLUDING, WITHOUT LIMITATION, ALL DAMAGES REFERENCED HEREIN AND ALL DIRECT OR GENERAL DAMAGES IN CONTRACT, TORT (INCLUDING NEGLIGENCE) OR OTHERWISE, THE ENTIRE AGGREGATE LIABILITY OF PFIZER AND ANY OF ITS DISTRIBUTORS AND/OR SUPPLIERS SHALL BE LIMITED TO THE MAXIMUM AMOUNT SET FORTH ABOVE FOR THE PRODUCT THAT IS SUBJECT TO THE PROGRAM. SOME STATES AND/OR JURISDICTIONS DO NOT ALLOW THE EXCLUSION OR LIMITATION OF INCIDENTAL OR CONSEQUENTIAL DAMAGES, SO THE ABOVE LIMITATIONS OR EXCLUSIONS MAY NOT APPLY TO YOU. THE LIMITATIONS OF LIABILITY SET FORTH ABOVE SHALL APPLY TO THE MAXIMUM EXTENT PERMITTED UNDER APPLICABLE LAW.
ARBITRATION: Read the following arbitration provision (“Provision”) carefully. It limits certain of your rights, including your right to obtain relief or damages through court action.
To begin Arbitration, either you or we must make a written demand to the other party for Arbitration for the applicable claim ("Claim"). The Arbitration will take place before a single arbitrator. It will be administered in keeping with the Expedited Procedures of the Commercial Arbitration Rules ("Rules") of the American Arbitration Association ("AAA") in effect when the Claim is filed. You may get a copy of the AAA's Rules by visiting www.adr.org. The filing fees to begin and carry out Arbitration will be shared equally between you and us. This does not prohibit the arbitrator from giving the winning party their fees and expenses for the Arbitration. Unless you and we agree, the Arbitration will take place in the county and state where you live. The Federal Arbitration Act, 9 U.S.C. Ch. 1, et seq., will govern, and not any state law on Arbitration. YOU AGREE AND UNDERSTAND THAT this Arbitration Provision means that you give up your right to go to court on any Claim covered by this provision. You also agree that any Arbitration proceeding will only consider your Claim. Claims by, or on behalf of, other individuals will not be arbitrated in any proceeding that is considering your Claim. THE DEGREE TO WHICH ARBITRATION CAN BE USED AS A DISPUTE RESOLUTION PROCESS FOR CONSUMER CLAIMS VARIES FROM STATE TO STATE, SO THIS ARBITRATION PROVISION MAY NOT APPLY TO YOU, DEPENDING ON YOUR STATE OF RESIDENCE. In the event this Arbitration provision is not approved by the appropriate state regulatory agency, and/or is stricken, severed, or otherwise deemed unenforceable by a court of competent jurisdiction, you and we specifically agree to waive and forever give up the right to a trial by jury. Instead, in the event any litigation arises between you and us, any such lawsuit will be tried before a judge, and a jury will not be impaneled or struck.
To report an adverse event, please call 1-800-438-1985
Pfizer for Professionals 1-800-505-4426
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