Free Trial Prescription Program
Get started and bring it
Patients prescribed XYNTHA for the first time may be eligible to receive a one-time, 1-month trial supply of 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.
Prescribed XYNTHA by your health care provider for the first time?
Follow the steps below to find out if you are eligible to access the XYNTHA Trial Prescription Program:
- 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 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 the 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 United States 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 Pfizer Factor Product Trial Prescription Program, please call 1.844.989.HEMO(4366) or write us at Pfizer Factor Product Trial Prescription Program Administrator, MedVantx, PO Box 5736, Sioux Falls, SD 57117-5736.