Welcome to the Pfizer Inflammation & Immunology (I&I) Co-Pay Portal

By using the Pfizer enCompass^® Co-Pay Assistance Program, you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions below:

• The Pfizer enCompass Co-Pay Assistance Program for ABRILADA is not valid for patients that 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").
• Program offer is not valid for cash-paying patients.
• Patients prescribed ABRILADA for adolescent hidradenitis suppurativa (HS), pediatric uveitis, or pediatric ulcerative colitis are not eligible for this co-pay savings program.
• With this program, eligible patients may pay as little as $0 co-pay per ABRILADA treatment, subject to a maximum benefit of $4,000-$14,000 per calendar year for out-of-pocket expenses for ABRILADA including co-pays or coinsurances. The amount of any benefit is the difference between your co-pay and $0. After the maximum benefit, you will be responsible for the remaining monthly out-of-pocket costs.
• Patient must have private insurance with coverage of ABRILADA.
• This offer is not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private insurance plans or other private health or pharmacy benefit programs.
• You must deduct the value of this assistance 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 program to any private insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the program, as may be required.
• You should not use the program if your insurer or health plan prohibits use of manufacturer co-pay assistance programs.
• This program is not valid where prohibited by law.
• This program cannot be combined with any other savings, free trial or similar offer for the specified prescription.
• 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. The rebate form can be found at https://patient.pfizeriandicopay.com.
• This program is not health insurance.
• This program is good only in the U.S. and Puerto Rico.
• This program is limited to 1 per person during this offering period and is not transferable.
• This offer cannot be redeemed more than once per 30 days per patient.
• No other purchase is necessary.
• Data related to your redemption of the program assistance 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 assistance redemptions and will not identify you.
• Pfizer reserves the right to rescind, revoke or amend this program without notice.
• This program may not be available to patients in all states.
• Card and Program expires 12/31/2024.

For more information about Pfizer, visit www.pfizer.com. For more information about the Pfizer enCompass Co-Pay Assistance Program, call Pfizer enCompass at 1-844-722-6672, or write to Pfizer enCompass Co-Pay Assistance Program 2730 S. Edmonds Lane, Suite 300, Lewisville, TX 75067.

By participating in the VELSIPITY Copay Savings Program and using the VELSIPITY Copay Savings Card (the "Program 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 Program benefit offer if they are enrolled in a state or federally funded insurance program, including but not limited to Medicare, Medicaid, TRICARE, Veteran 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. Patients who move from private insurance to the above-mentioned state or federal healthcare insurance programs will no longer be eligible.
• Patients are not eligible to use the medical assessment benefit offer if they are enrolled in a state or federally funded insurance program, including but not limited to Medicare, Medicaid, TRICARE, Veteran 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"). Patients who move from private insurance to the above-mentioned state or federal healthcare programs will no longer be eligible.
• Offer is only available to patients who have been diagnosed with an FDA-approved indication for VELSIPITY (etrasimod).
• Patient must have private insurance. Offer is not valid for cash paying patients.
• The Program includes a prescription benefit offer for out-of-pocket drug costs. The value of the prescription benefit offer is limited to the amount of your copay. Patients may pay as little as $0 in out-of-pocket costs per prescription, subject to a maximum benefit of $16,000 during a calendar year.
• The value of the offer also includes a medical benefit offer for reimbursement of qualified out-of-pocket expenses is a one-time reimbursement amount of up to $2,500, which include baseline assessments/prescreening tests for the initial blood tests, ECG screening, eye exam, and baseline skin examination where the full cost is not covered by patient's insurance. This medical benefit offer only applies to the above-mentioned qualified expenses and is not eligible for patients residing in Minnesota or Rhode Island.
• To receive reimbursement for qualified out-of-pocket expenses, an Explanation of Benefits (EOB) form must be submitted, along with copies of receipts for any payments made. After the $2,500 maximum is reached, you will be responsible for paying the remaining monthly out-of-pocket costs.
• Patients may pay as little as $0 in out-of-pocket costs for the above-mentioned qualified expenses, subject to a maximum one-time benefit of $2,500. To receive the medical assessment benefit, an Explanation of Benefits (EOB) form must be submitted, along with copies of receipts for any payments made. Patients must have a VELSIPITY Copay Savings Card to participate in the medical benefit offer.
• After a maximum is reached, you will be responsible for paying the remaining monthly out-of-pocket costs.
• Patient must be 18 years of age or older.
• This Program is not valid when the entire cost of your prescription drug and/or qualified out-of-pocket expense are eligible to be reimbursed by your private insurance plan or other private health or pharmacy benefit programs.
• You must deduct the value of this 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 Card to any private insurer, health plan, or other third party who pays for or reimburses any part of the prescription and/or medical benefit for qualified out-of-pocket expenses filled using this Program, as may be required.
• You should not use this Program if your insurer or health plan prohibits use of manufacturer Cards.
• The program is not valid where prohibited by law.
• This program cannot be combined with any other savings, free trial, or similar offer for the specified prescription.
• The prescription offer of the Copay Savings Program will be accepted only at participating pharmacies.
• If your pharmacy does not participate, you may be able to submit a request for a rebate of the cost for the prescription in connection with this offer. The rebate form can be found at www.VELSIPITY.com.
• The Copay Savings Program is not health insurance.
• Offer good only in the U.S. and Puerto Rico. The Card is limited to 1 per person during this offering period and is not transferable.
• The Card may not be redeemed more than once per 30 days per patient.
• No other purchase is necessary.
• Data related to your redemption of the Card may be collected, analyzed, and shared with Pfizer, for market research and other purposes related to assessing Pfizers programs.
• Pfizer reserves the right to rescind, revoke, or amend the program without notice.
• Program expires 12/31/2024.

If you have questions or are in need of additional support, call 800-350-3080, visit www.VELSIPITY.com or mail VelsipityForMe at 2730 S. Edmonds Lane, Suite 300, Lewisville TX 75067.