Free Trial Prescription Program
Get started and bring it
Eligible patients can try the proven bleed control and protection for free.
If you've been prescribed XYNTHA for the first time, you may be eligible to receive a one-time, 1-month trial supply up to 20,000 IU at no cost.
This program is available only for first-time use by commercially insured patients. Medicare/Medicaid beneficiaries are not eligible.*
*Terms and conditions apply.
Find out if you’re eligible to access the XYNTHA Trial Prescription Program. Simply:
- Download enrollment form
- Bring it to your next visit with your health care provider
- Work with your health care provider to complete and submit the enrollment form
OFFER TERMS: By enrolling in the 1-month trial program for Pfizer Factor Product, you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions described below:
You (the patient) are currently covered by a private (commercial) insurance plan. The patient, or health care provider on the patient’s behalf, must provide a completed enrollment form and a valid prescription to the Pfi er Factor Product Trial Prescription Program. The program is valid for one 1-month trial of up to 20,000 IU of factor. Trial cannot exceed 30 days. The patient, or the health care provider on the patient’s behalf, must not submit any claim for reimbursement for product dispensed pursuant to this program to any third-party payer, including Medicaid, Medicare, or any other federal or state health care program. The patient must not apply the value of the free product received through this program toward any government insurance benefi out-of-pocket spending calculations, such as Medicare Part D True Out-of-Pocket Costs (TrOOP). The free trial offer is not valid for prescriptions that are eligible to be reimbursed by private insurance plans or health or pharmacy benefi programs that reimburse you for the entire cost of your prescription drugs. Patients who have already begun therapy with or who have been treated with Pfi er Factor Product are not eligible to participate in the program. Only new patients may use this offer. Only 1 program enrollment per person per lifetime. By enrolling in this program, you certify that you are not currently using Pfi er Factor Product. Program not available where prohibited by law. This free trial is not health insurance. This free trial is not intended to address delays or gaps in health insurance coverage for the specific prescription. This program cannot be combined with any other savings, free trial, or similar offers for the specific prescription. The free trial offer will only be accepted by participating factor providers. Offer good only in the United States and Puerto Rico. No purchase is necessary. Patients have no obligation to continue to use Pfizer Factor Product. This offer is not transferable. Pfizer reserves the right to rescind, revoke, or amend this free trial program without notice. This free trial program expires 12/31/2024. No membership fees. For questions about the Pfizer Factor Product Trial Prescription Program, please call 1-844-989-HEMO (4366) or write to us at Pfizer Factor Product Trial Prescription Program Administrator, Medvantx, PO Box 5736, Sioux Falls, SD 57117-5736.
