Support | OCTAGAM® 10% (Immune Globulin Intravenous (Human) 10% Liquid Preparation)

Eligible patients may pay as little as $0 for OCTAGAM 5%*

Patients must have commercial insurance to be eligible
Patients are not eligible if they are enrolled in a state or federally funded insurance program

*Eligible, commercially insured patients may pay as little as $0 for OCTAGAM 5% and may receive a maximum benefit of $12,500 per calendar year or the cost of patient’s co-pay in a 12-month period (whichever is less) for claims received by the program. Terms and conditions/eligibility requirements apply. See full terms and conditions here.

For eligible patients prescribed OCTAGAM 5%, the co-pay program is available through specialty infusion pharmacies.

Contact your specialty infusion pharmacy to see if you are eligible.

What is Pfizer IGuide™?

Pfizer IGuide™ can help you understand your insurance coverage and out-of-pocket costs for your prescribed OCTAGAM 5%, as well as identify financial assistance options for which you may be eligible.

If you have been prescribed OCTAGAM 5% and have questions about your coverage, call Pfizer IGuide™ Monday through Friday, 8 AM to 8 PM ET, at 1-844-448-4337.

Visit PfizerIGuide.com for help with enrollment, financial assistance, and insurance support services.

Financial Assistance

Pfizer IGuide™ can help identify financial assistance resources for which you may be eligible to help with out-of-pocket costs for OCTAGAM

Commercially Insured Patients

If you have commercial, employer, or private coverage, including coverage purchased through a state health insurance marketplace, you may be eligible for the OCTAGAM Co-Pay Program, which can help cover the cost of your co-pay. Eligible patients may pay as little as $0 per OCTAGAM treatment. The value of the co-pay card is limited to a maximum of $12,500 per calendar year. See terms and conditions below

Medicare/Government-Insured Patients

If you have government-funded insurance and need help to cover the cost of OCTAGAM, Pfizer IGuide™ can help identify financial support options including alternate coverage resources, if available

Uninsured Patients

If you do not have health insurance and cannot afford your OCTAGAM treatment, Pfizer IGuide™ can connect you to potential resources that may help cover the cost of OCTAGAM, including how to apply to Medicaid if you may be eligible for Octagam 10% and 2 years of age or older to be eligible for the co-benefit for Octagam 5%

The Pfizer OCTAGAM Co-Pay Program Terms and Conditions for Patients

TERMS AND CONDITIONS

By using this co-pay card, you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions described below:

Patients are not eligible to use this card if they are enrolled in a state or federally funded insurance program, including but not limited to Medicare, Medicaid, TRICARE, Veterans Affairs health care, a state prescription drug assistance program, or the Government Health Insurance Plan available in Puerto Rico (formerly known as “La Reforma de Salud”).
Patient must have private insurance. Offer is not valid for cash paying patients. The value of this co-pay card is limited to a maximum of $12,500 per calendar year or the cost of patient co-pay in a 12-month period, whichever is less.
This co-pay card is not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private insurance plan or other private health or pharmacy benefit programs.
You must deduct the value of this co-pay card from any reimbursement request submitted to your private insurance plan, either directly by you or on your behalf.
You are responsible for reporting use of the co-pay card to any private insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the co-pay card, as may be required. You should not use the co-pay card if your insurer or health plan prohibits use of manufacturer co-pay cards.
Patient must be 18 years of age or older to be eligible for the co-pay benefit for Octagam 10% and 2 years of age or older to be eligible for the co-benefit for Octagam 5%.
This co-pay card is not valid where prohibited by law.
The benefit under the co-pay card program is offered to, and intended for the sole benefit of, eligible patients and may not be transferred to or utilized for the benefit of third parties, including, without limitation, third party payers, pharmacy benefit managers, or the agents of either.
Co-pay card cannot be combined with any other savings, free trial or similar offer for the specified prescription cannot be combined with any other savings, free trial or similar offer for the specified prescription (including any program offered by a third party payer or pharmacy benefit manager, or an agent of either, that adjusts patient cost-sharing obligations, through arrangements that may be referred to as “accumulator” or “maximizer” programs).
Third party payers, pharmacy benefit managers, or the agents of either, are prohibited from assisting patients with enrolling in the [coupon/co-pay card] program.
Co-pay card will be accepted only at participating pharmacies.
If your pharmacy does not participate, you may be able to submit a request for a rebate in connection with this offer.
This co-pay card is not health insurance.
Offer good only in the U.S. and Puerto Rico.
Co-pay card is limited to 1 per person during this offering period and is not transferable.
A co-pay card may not be redeemed more than once per 30 days per patient.
No other purchase is necessary.
No membership fee.
Data related to your redemption of the co-pay card may be collected, analyzed, and shared with Pfizer for market research and other purposes related to assessing Pfizer's programs. Data shared with Pfizer will be aggregated and de-identified; it will be combined with data related to other co-pay card redemptions and will not identify you.
Pfizer reserves the right to rescind, revoke or amend this offer without notice.
Offer expires 12/31/2025.

For more information, call 1-866-642-7606, visit www.octagaminfo.com/octagam-5, or write:

Octagam Co-Pay Program
P.O. Box 6875
Bridgewater, NJ 08807

COLLAPSE

INDICATION AND USAGE

OCTAGAM® 5% [Immune Globulin Intravenous (Human)] liquid is indicated for the treatment of primary humoral immunodeficiency (PI).

OCTAGAM 5% is a liquid medication that contains Immunoglobulin G (IgG). OCTAGAM 5% is made from human blood plasma donated by healthy people. OCTAGAM 5% is given through the vein (intravenously) in a hospital, infusion center, or at home.

IMPORTANT SAFETY INFORMATION

Do not use OCTAGAM 5% if you have had a severe allergic reaction to IgG or other blood products or have deficiencies of immunoglobulin A (IgA) with antibodies to IgA
OCTAGAM 5% can cause the following:

Blood clots in your heart, brain, lungs, or other areas of your body
Kidney problems, or kidney failure

Do not use OCTAGAM 5% if you are allergic to corn
OCTAGAM 5% can cause the following:

Tell your healthcare provider (HCP) if you have an allergy to corn. OCTAGAM 5% contains a type of sugar that is made from corn

OCTAGAM 5% can cause the following serious side effects. Contact your HCP if you experience the following:

Swelling in your mouth or throat, hives/itching, breathing problems, wheezing, fainting, tightness in your chest, or dizziness. This could be a serious allergic reaction
Decreased urination, swelling in your legs, sudden weight gain, or breathing problems, which could be signs of kidney failure
Pain and/or swelling of an arm or leg with warmth in the affected area, discoloration of an arm or leg, unexplained shortness of breath, chest pain or discomfort that worsens with deep breathing, unexplained rapid pulse, or numbness or weakness on one side of the body; these could be signs of a blood clot
Yellow skin or eyes, dark-colored urine, fatigue, or increased heart rate, which could be signs of a blood problem
Headache, stiff neck, drowsiness, fever, sensitivity to light, painful eye movements, or nausea and vomiting, which could mean an inflammation of the membranes covering your brain or spinal cord
Trouble breathing, chest pain, blue lips, arms or legs, and fever, which could be related to a lung problem. This typically occurs 1 to 6 hours following infusion

Common side effects include headache and nausea.

If you use a blood glucose monitor, check with your HCP to ensure that your type of monitor and test strips can be used while you are receiving OCTAGAM 5%.

These are not all of the possible side effects with OCTAGAM 5%. Tell your HCPs about any side effects that you have.

Please see Full Prescribing Information, including complete BOXED WARNING, available here for OCTAGAM 10% or here for OCTAGAM 5%.

Patients should always ask their doctors for medical advice about adverse events.

You may report an adverse event related to Pfizer products by calling 1-800-438-1985 (US only). If you prefer, you may contact the US Food and Drug Administration (FDA) directly. The FDA has established a reporting service known as MedWatch where healthcare professionals and consumers can report problems they suspect may be associated with the drugs and medical devices they prescribe, dispense, or use. Visit www.fda.gov/MedWatch or call 1-800-FDA-1088

OCTAGAM® is a registered trademark of Octapharma AG.

This site is intended only for U.S. residents. The products discussed in this site may have different product labeling in different countries. The information provided is for educational purposes only and is not intended to replace discussions with a healthcare provider.

Pfizer

PO Box 29309

Mission, KS 66201

PP-OTG-USA-0269-01
December 2023

Manufactured by Octapharma Pharmazeutika Produktionsges m.b.H. Distributed by
Octapharma USA Inc.