Free Trial Prescription Program
Get started and bring it
Get up to 20,000 IU of XYNTHA at no cost with the XYNTHA Trial Prescription Program.*
You may be eligible to receive a one-time 1-month supply up to 20,000 IU of XYNTHA at no cost. Talk to your health care provider to see if XYNTHA is right for you, and follow the steps below.
*Terms and conditions apply.
3 steps to get started:
- Download the discussion guide and enrollment form
- Bring it to your next visit with your health care provider
- Ask your health care provider if XYNTHA is right for you
When you download this document, the full Prescribing Information will be included.
OFFER TERMS: By enrolling in the XYNTHA Trial Prescription Program, you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions described below: You are currently covered by a private [commercial] insurance plan. An original free trial offer and a valid prescription must be presented. No claim for reimbursement for XYNTHA dispensed pursuant to this free trial offer may be submitted to any third-party payor. Medicaid, Medicare, or any other federal or state health care program beneficiaries are not eligible for this offer (this includes any state prescription drug assistance programs and Government Health Insurance Plan, available in Puerto Rico, formerly known as “La Reforma de Salud”). The free trial offer is not valid for prescriptions that are eligible to be reimbursed by private insurance plans or health or pharmacy benefit programs that reimburse you for the entire cost of your prescription drugs. This free trial offer is not valid where otherwise prohibited by law. You will receive a 1-month supply up to 20,000 IU of factor. The free trial offer cannot be combined with any other rebate/coupon, free trial, or similar offer for the prescribed prescription. The free trial offer will only be accepted by participating factor providers. This free trial offer is not health insurance. Offer good only in the U.S. and Puerto Rico. Only new patients may use this offer. By redeeming this offer, you certify that you are not currently using XYNTHA. Only 1 offer per person may be redeemed under this program. This offer is not transferable. Pfizer reserves the right to rescind, revoke, or amend this free trial offer without notice. Offer expires 1 month from enrollment date or when the maximum benefit up to 20,000 IU at no cost has been reached. No membership fees.
For questions about the XYNTHA Trial Prescription Program, please call 1-800-710-1379 or write us at XYNTHA Trial Prescription Program Administrator, MedVantx, PO Box 5736, Sioux Falls, SD 57117-5736.
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