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Eligible, commercially insured patients may pay as little as $0 a month for BOSULIF (bosutinib). Limits, terms, and conditions apply. See below for details.

CHECK YOUR ELIGIBILITY

Please select “yes” or “no” for the following questions. Your answers will determine your eligibility for the Pfizer Co-Pay One Program.
Please select “yes” or “no” for the following questions.
Your answers will determine your eligibility for the Pfizer Co-Pay One Program.

Eligible, commercially insured patients may pay as little as $0 a month for BOSULIF (bosutinib). Limits, terms, and conditions apply. See below for details.

Terms and Conditions

By enrolling in this co-pay offer, you acknowledge that you currently meet the eligibility criteria and will comply with the Terms and Conditions described below:

  • The offer is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, or other federal or state healthcare programs (such as any state prescription drug assistance programs and the Government Health Insurance Plan available in Puerto Rico [formerly known as “La Reforma de Salud”]).
  • The offer is not valid for prescriptions that are eligible to be reimbursed by private insurance plans or other health or pharmacy benefit programs, which reimburse you for the entire cost of your prescription drugs.
  • You are responsible for $10 or the full amount of your co-pay, whichever is less, for each monthly prescription of a covered medicine. The amount of any savings is the difference between your co-pay and $10. You are entitled to maximum savings of $25,000 per calendar year per patient.
  • You must deduct the value received under this program from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf.
  • Cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription.
  • The offer will be accepted only at participating pharmacies.
  • This offer is not health insurance.
  • Offer good only in the United States and its territories.
  • Pfizer reserves the right to rescind, revoke, or amend the program without notice.
  • Program expires 12/31/2017.
  • No membership fees.
  • The offer is limited to 1 per person during this offering period and is not transferable.
  • For reimbursement when using a nonparticipating pharmacy: Mail a copy of your pharmacy receipt indicating patient name, name of medication purchased, price paid, and date purchased, along with a copy of your Pfizer Co-Pay One Savings Card, to:

Pfizer Co-Pay One Savings Card

2250 Perimeter Park Drive, Suite 300

Morrisville, NC 27560

Terms and Conditions

By enrolling in this co-pay offer, you acknowledge that you currently meet the eligibility criteria and will comply with the Terms and Conditions described below:

  • This card is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, Tricare or other federal or state healthcare programs (including any state prescription drug assistance programs) and the Government Health Insurance Plan available in Puerto Rico (formerly known as “La Reforma de Salud”).
  • This card is not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private insurance plans or other health or pharmacy benefit programs.
  • With this card you will pay a $0 co-pay per eligible monthly prescription, subject to a maximum benefit of $25,000 per calendar year. The amount of any benefit is the difference between your co-pay and $0. After the maximum of $25,000 you will be responsible for the remaining monthly out-of-pocket costs. This card may be used once per 30 days until the maximum benefit has been reached. The average benefit is $572.73 per patient per year.
  • You must deduct the value of the benefit you receive with this card from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf.
  • This card is not valid where prohibited by law.
  • Card cannot be combined with any other rebate/coupon, free trial or similar offer for the specified prescription.
  • Card will be accepted only at participating pharmacies.
  • This card is not health insurance.
  • Offer good only in the U.S. and Puerto Rico.
  • Card is limited to 1 per person during this offering period and is not transferable.
  • Pfizer reserves the right to rescind, revoke or amend this offer without notice.
  • No membership fee.
  • Offer expires 12/31/2019.
  • For reimbursement when using a nonparticipating pharmacy: Mail a copy of the patient’s pharmacy receipt indicating patient name, name of medication purchased, price paid, and date purchased, along with a copy of the patient’s Pfizer Co-Pay One Savings Card, to:

Pfizer Co-Pay One Savings Card

2250 Perimeter Park Drive, Suite 300

Morrisville, NC 27560

BOSULIF may cause serious side effects, including:

  • Stomach problems. BOSULIF may cause stomach (abdomen) pain, nausea, diarrhea, or vomiting. Tell your doctor about any stomach problems
  • Low blood cell counts. BOSULIF may cause low platelet counts (thrombocytopenia), low red blood cell counts (anemia) and low white blood cell counts (neutropenia). Your doctor should do blood tests to check your blood cell counts regularly during your treatment with BOSULIF. Call your doctor right away if you have unexpected bleeding or bruising, blood in your urine or stools, fever, or any signs of an infection
  • Liver problems. BOSULIF may cause liver problems. Your doctor should do blood tests to check your liver function regularly during your treatment with BOSULIF. Call your doctor right away if your skin or the white part of your eyes turns yellow (jaundice) or you have dark “tea color” urine
  • Your body may hold too much fluid (fluid retention). Fluid may build up in the lining of your lungs, the sac around your heart, or your stomach cavity. Call your doctor right away if you get any of the following symptoms during your treatment with BOSULIF:
    • – shortness of breath and cough
    • – chest pain
    • – swelling in your hands, ankles, or feet
    • – swelling all over your body
    • – weight gain
  • Kidney problems. BOSULIF may cause kidney problems. Your doctor should do tests to check your kidney function when you start treatment with BOSULIF and during your treatment. Call your doctor right away if you get any of the following symptoms during your treatment with BOSULIF:
    • you urinate more or less often than normal
    • you make a much larger or smaller amount of urine than normal
  • The most common side effects of BOSULIF include: diarrhea, nausea, low blood cell counts, rash, vomiting, stomach pain, respiratory tract infection, fever, abnormal liver function, tiredness or weakness, cough, and headache

Before you take BOSULIF, tell your doctor if you:

  • have liver problems
  • have heart problems
  • have kidney problems
  • have any other medical conditions
  • are pregnant or plan to become pregnant. BOSULIF can harm your unborn baby. You should not become pregnant while taking BOSULIF. Tell your doctor right away if you become pregnant while taking BOSULIF
  • are a woman who may become pregnant. Use effective contraception (birth control) during and for at least 30 days after completing treatment with BOSULIF. Talk to your doctor about forms of birth control
  • are breastfeeding or plan to breastfeed. It is not known if BOSULIF passes into your breast milk or if it can harm your baby. You and your doctor should decide if you will take BOSULIF or breastfeed. You should not do both

BOSULIF may cause serious side effects, including:

  • Stomach problems. BOSULIF may cause stomach (abdomen) pain, nausea, diarrhea, or vomiting. Tell your doctor about any stomach problems
  • Low blood cell counts. BOSULIF may cause low platelet counts (thrombocytopenia), low red blood cell counts (anemia) and low white blood cell counts (neutropenia). Your doctor should do blood tests to check your blood cell counts regularly during your treatment with BOSULIF. Call your doctor right away if you have unexpected bleeding or bruising, blood in your urine or stools, fever, or any signs of an infection
  • Liver problems. BOSULIF may cause liver problems. Your doctor should do blood tests to check your liver function regularly during your treatment with BOSULIF. Call your doctor right away if your skin or the white part of your eyes turns yellow (jaundice) or you have dark “tea color” urine
  • Your body may hold too much fluid (fluid retention). Fluid may build up in the lining of your lungs, the sac around your heart, or your stomach cavity. Call your doctor right away if you get any of the following symptoms during your treatment with BOSULIF:
    • – shortness of breath and cough
    • – chest pain
    • – swelling in your hands, ankles, or feet
    • – swelling all over your body
    • – weight gain
  • Kidney problems. BOSULIF may cause kidney problems. Your doctor should do tests to check your kidney function when you start treatment with BOSULIF and during your treatment. Call your doctor right away if you get any of the following symptoms during your treatment with BOSULIF:
    • – you urinate more or less often than normal
    • – you make a much larger or smaller amount of urine than normal
  • The most common side effects of BOSULIF include: diarrhea, nausea, low blood cell counts, rash, vomiting, stomach pain, respiratory tract infection, fever, abnormal liver function, tiredness or weakness, cough, and headache

Before you take BOSULIF, tell your doctor if you:

  • have liver problems
  • have heart problems
  • have kidney problems
  • have any other medical conditions
  • are pregnant or plan to become pregnant. BOSULIF can harm your unborn baby. You should not become pregnant while taking BOSULIF. Tell your doctor right away if you become pregnant while taking BOSULIF
  • are a woman who may become pregnant. Use effective contraception (birth control) during and for at least 30 days after completing treatment with BOSULIF. Talk to your doctor about forms of birth control
  • are breastfeeding or plan to breastfeed. It is not known if BOSULIF passes into your breast milk or if it can harm your baby. You and your doctor should decide if you will take BOSULIF or breastfeed. You should not do both