Please confirm if any of the following statements are true for the person enrolling:

All fields required unless otherwise noted.

• I have insurance from any federal healthcare program (including Medicare, Medicaid, TRICARE, or any other state or federal medical pharmaceutical benefit program or pharmaceutical assistance program)
• My partner and I are both over 65 years of age and retired
• I receive Social Security Disability Insurance (SSDI) or any other Social Security Administration (SSA) benefit
• I receive insurance from the military

We’re sorry, you are not eligible for the Co-Pay Savings Program.

You may still qualify for PAXLOVID at no charge,* or you may qualify for other programs.^† Please visit PAXCESSpatientportal.com for more information or reach out to 1-877-C19-PACK (1-877-219-7225) to see what options may be available for you.

^*Other administrative fees may apply.
^†With a focus on ensuring access for patients, the U.S. Government Patient Assistance Program (USG PAP) operated by Pfizer will continue to provide patients on Medicare, Medicaid, TRICARE, VA Community Care Network, and those who are uninsured access to PAXLOVID for free through December 31, 2024. PAXLOVID through USG PAP is not available to patients who have commercial prescription drug health insurance. The USG PAP operated by Pfizer is an independent program with separate eligibility requirements offered by the United States Department of Health and Human Services and is not owned by Pfizer. Terms and conditions apply. Full terms and conditions for the USG PAP may be found here.

By checking this box, I confirm that I am eligible to participate in this program and agree to the Terms and Conditions specified here. Please agree to the Terms and Conditions before proceeding.

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