Financial Assistance |Lorbrena® (lorlatinib) Patient Site |Safety Info

PATIENT FINANCIAL ASSISTANCE

We'll help you find financial assistance options for your prescribed LORBRENA, including a co-pay savings program for eligible, commercially insured patients. Limits, terms, and conditions apply. We can also help identify resources if you have Medicare, another government insurance plan, or don't have health insurance.

Turn to Pfizer Oncology Together™ to learn about financial assistance resources and get personalized support from one of our dedicated Care Champions.

COMMERCIALLY INSURED

Resources for eligible patients with commercial, private, employer, or state health insurance marketplace coverage:

Co-pay assistance

Eligible, commercially insured patients may pay as little as $0 per month for their Pfizer Oncology treatment. Limits, terms, and conditions apply.* Patients may receive up to $10,000 per product in savings annually.

Pay as little as $0 for LORBRENA (lorlatinib) with the Co-Pay Savings Card

*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.

MEDICARE/GOVERNMENT INSURED

Help identifying resources for eligible patients with Medicare/Medicare Part D, Medicaid, or other government insurance plans who express a financial need:

	We can assist patients with searching for financial support from alternate funding resources, which may include financial assistance through Extra Help, a Medicare Part D Low-Income Subsidy (LIS) program
	If support from alternate funding resources or Medicare Extra Help is not available, Pfizer Oncology Together will see if patients are eligible for the Pfizer Patient Assistance Program,* which can provide prescribed Pfizer Oncology medicines for free
	Oncology medicines for free^†

^†The Pfizer Patient Assistance Program is a joint program of Pfizer Inc. and the Pfizer Patient Assistance Foundation™. Free medicines from Pfizer are provided through the Pfizer Patient Assistance Foundation™. The Pfizer Patient Assistance Foundation™ is a separate legal entity from Pfizer Inc. with distinct legal restrictions.

UNINSURED

Help identifying resources for eligible patients without any form of healthcare coverage:

	We can check patient eligibility for Medicaid and help them understand how to apply
	Patients who do not qualify for Medicaid may receive free medicine through the Pfizer Patient Assistance Program.^‡ Patients must be eligible and reapply as needed

^‡The Pfizer Assistance Program is a joint program of Pfizer Inc. and the Pfizer Patient Assistance Foundation™. Free medicines from Pfizer are provided through the Pfizer Patient Assistance Foundation™. The Pfizer Patient Assistance Foundation™ is a separate legal entity from Pfizer Inc. with distinct legal restrictions.

^§The Pfizer Savings Program is not health insurance. For more information, call the toll-free number: 1-877-744-5675.
There are no membership fees to participate in this program. Estimated savings are 50% and depend on such factors as the particular drug purchased, amount purchased, and the pharmacy where purchased.

Downloadable Resources

	Discussion Guide for Patients and Healthcare Providers: ALK+ mNSCLC This guide helps you raise questions to your doctors to learn more about your diagnosis, treatment, how treatment may affect your lifestyle, and what resources are available to you. Click here to download
	Patient Brochure (available in English and Spanish) Download this brochure to learn about what LORBRENA® (lorlatinib) is and how it works. Click here to download in English Click here to download in Spanish
	Patient Guide to Common Side Effects Review common side effects that you may experience during treatment with LORBRENA® (lorlatinib), as well as when the side effects are likely to occur, in a timeline graphic. This guide also provides strategies to discuss with your care team. Click here to download
	What to Expect Brochure You can use this guide to learn about potential side effects you may experience while taking LORBRENA® (lorlatinib), including strategies you can discuss with your care team. Click here to download
	Patient Journal Print out this personal journal in which you can record and reflect on your experience while taking LORBRENA® (lorlatinib). Click here to download
	7 Tips from Care Partners to Help Navigate Your Loved One’s Lung Cancer Care partners of lung cancer patients share their advice, the challenges they face, and tips to help other care partners navigate this disease with their loved ones. Click here to download
	Patient Experience Brochure This brochure will provide advice and practical help for patients and their loved ones navigating life after a cancer diagnosis. This resource may be helpful for any cancer patient, regardless of which treatment they are on, as it is not specific to LORBRENA. Click here to download

USEFUL LINKS

If you’re looking to find the latest cancer research or helpful support communities, here are some third-party resources to check out.

It's also a good idea to check with your hospital or cancer care team for information about support groups near you.

Third-party websites are neither owned nor controlled by Pfizer. Pfizer does not endorse and is not responsible for the content or services of these sites.

INFORMATION ABOUT LUNG CANCER

ALK Positive

www.alkpositive.org

ALK Positive Inc. is a patient-driven organization that seeks a cure for ALK-positive cancer and works to improve patients’ quality of life and life expectancy worldwide.

American Cancer Society

www.cancer.org

The American Cancer Society funds and conducts research, shares expert information, and provides support for patients and their loved ones who have been affected by cancer.

Lung Cancer Research Foundation

www.LCRF.org

The Lung Cancer Research Foundation focuses on funding research for the prevention, diagnosis, treatment, and cure for lung cancer, providing awareness and educational programs supporting the lung cancer community.

GO₂ for Lung Cancer

www.go2.org

GO₂ for Lung Cancer relentlessly confronts lung cancer on every front, every day, for everyone. Founded by patients and survivors, they are dedicated to increasing survival for those at risk, diagnosed, and living with lung cancer.

They are the go-to for one-on-one assistance, supportive connections, treatment information, and finding the best care close to home.

Lung Cancer Foundation of America

www.lcfamerica.org

Lung Cancer Foundation of America is working to change the public perception of lung cancer through education and personal stories about lung cancer and to improve patient outcomes through funding impactful research.

LUNGevity Foundation

www.lungevity.org

LUNGevity Foundation is transforming what it means to be diagnosed and live with lung cancer. LUNGevity seeks to make an immediate impact on quality of life and survivorship for everyone touched by the disease through research, community, and advocacy.

REGISTER FOR LORBRENA SUPPORT

Use this form to register for additional resources and support, including the LORBRENA Patient Starter Kit.

We are committed to providing support and resources designed for LORBRENA® patients and their support team. Choose the support you’d like to receive by completing the form below.

Please complete errors below in red to register

All fields are required except where marked optional.

By filling out this form, you acknowledge you are over 18 years of age.

We are committed to providing support and resources designed for LORBRENA® patients and their support team. Choose the support you’d like to receive by completing the form below.

Please complete errors below in red to register

All fields are required except where marked optional.

By filling out this form, you acknowledge you are over 18 years of age.

I am a

Patient taking LORBRENA

Caregiver of a patient taking LORBRENA

Please choose one.

Please tell us the support you’d like to register for.

(select all that apply)

$0 Co-Pay Savings Card

LORBRENA Patient Starter Kit via Mail

Additional Support & Resources via Email

Please select checkbox.

Email Address

First Name

Last Name

Address

Address 2 (Optional)

City

Select State

ZIP Code

Please verify the following information to receive a $0 Co-Pay Savings Card^¶

I currently live in the United States or Puerto Rico.
I do not have insurance from any federal healthcare program (including Medicare, Medicaid, TRICARE, or any other state or federal medical pharmaceutical benefit program or pharmaceutical assistance program).
I am not over 65 years of age and retired, and if applicable, neither is my partner.
I do not receive Social Security Disability or any other Social Security Administration benefit.
I do not have end stage renal disease.
I am not active duty military, and if applicable, neither is an immediate family member.
I agree with the Terms and Conditions

I meet the defined requirements.

Please make a selection.

Privacy Statement

Pfizer understands your personal and health information are private. The information you provided will be used by Pfizer and parties acting on its behalf to send you communications in accordance to Pfizer's Privacy Policy.

By checking this box, I also agree to receive communications from Pfizer Oncology Together, a support program that offers financial assistance and personalized resources for patients prescribed Pfizer Oncology medicines.

By clicking "submit," you agree to share your contact information and certain health information with Pfizer and Pfizer's service providers and grant permission for those entities to send you helpful information regarding Pfizer's products, treatments, and offers. Pfizer values your privacy; this personal information will be handled in accordance with our Privacy Policy. You can unsubscribe from these communications at any time by clicking “Unsubscribe” in the communications you receive.

^¶Pfizer Oncology Together Co-Pay Savings Program

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:

This co-pay card is not valid for prescriptions that are reimbursed, in whole or in part, by Medicaid, Medicare, TRICARE, Veterans Affairs health care, or any other federal or state health care program (including any state prescription drug assistance program), or the Government Health Insurance Plan available in Puerto Rico (formerly known as “La Reforma de Salud”).
The value of this co-pay card is limited to $9,450 per use or the amount of your co-pay, 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.
Patients who are enrolled in Medicare, Medicaid, or another state or federal health care program may use the co-pay card if paying for the prescription covered by the co-pay card outside of their government insurance benefit, and no claim is submitted to Medicare, Medicaid or any federal or state health care program. Such patients must not apply any out-of-pocket expenses incurred using the co-pay card toward any government insurance benefit out-of-pocket spending calculations, such as Medicare Part D true out-of-pocket (TrOOP) costs.
You are responsible for reporting use of this 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.
You must be 18 years of age or older to redeem the co-pay card.
This co-pay card is not valid for Massachusetts residents whose prescriptions are covered in whole or in part by third party insurance.
This co-pay card is not valid for California residents whose prescriptions are covered in whole or in part by third party insurance.
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 external 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 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.
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 12/31/2024.
If your pharmacy does not participate, you may be able to submit a request for a rebate in connection with this offer:
- Mail a copy of the patient’s original pharmacy receipt indicating patient name, name of medication purchased, price paid, and date purchased, accompanying your prescription, as proof of purchase, along with a copy of the patient’s Pfizer Oncology Together Co-Pay Savings Card, to:
  
  Pfizer Oncology Together Co-Pay Savings Program
  2250 Perimeter Park Drive, Suite 300,
  Morrisville, NC 27560.
  Receipt will not be returned.
- The patient will receive a maximum of $9,450 per product per calendar year or the amount of the co-pay paid, whichever is less.
- Rebate will be mailed to patients approximately 6 to 8 weeks after receipt of required documentation or earlier, as required by law.

Important Safety Information and Indication

Important Safety Information

LORBRENA^® (lorlatinib) may cause serious side effects, including:

Liver problems due to interactions with other medicines. It is important to know what medicines should not be taken with LORBRENA.
Central nervous system (CNS) effects. LORBRENA may cause CNS effects, including problems with thinking (such as forgetfulness or confusion), changes in mood (such as depression and thoughts about suicide or dying), psychotic effects such as seeing or hearing things that are not real (hallucinations), seizures, changes in speech and changes in sleep. Tell your healthcare provider if you experience new or worsening symptoms of CNS effects.
Increases in the cholesterol and triglycerides (lipid) levels in your blood. Most people will have an increase in the lipid levels in their blood during treatment with LORBRENA.
- If you have increases in the lipid levels in your blood during treatment with LORBRENA, your healthcare provider may need to start you on a medicine to lower the levels. If you are already taking a medicine to lower the lipid levels in your blood, your healthcare provider may need to increase your dose of that medicine.
- Your healthcare provider should do blood tests to check the lipid levels in your blood before starting treatment, 1 to 2 months after starting treatment, and during treatment with LORBRENA.
Heart problems. LORBRENA may cause very slow or abnormal heartbeats. Your healthcare provider should check your heart rhythm (electrocardiogram or EKG) before starting and during treatment with LORBRENA. Tell your healthcare provider right away if you feel dizzy or faint or have abnormal heartbeats. In some people, these problems are severe, and your healthcare provider may need to have you stop taking LORBRENA or have a pacemaker placed.
Lung problems. LORBRENA may cause severe or life-threatening swelling (inflammation) of the lungs during treatment that can lead to death. Symptoms may be similar to those from lung cancer. Tell your healthcare provider right away if you have any new or worsening symptoms of lung problems, including trouble breathing, shortness of breath, cough, or fever.
High blood pressure (hypertension). Your healthcare provider should check your blood pressure before starting treatment, 2 weeks after starting treatment, and then at least every month during treatment with LORBRENA. Your healthcare provider may need to start or change your blood pressure medicine if you have high blood pressure during treatment with LORBRENA. Tell your healthcare provider right away if you get signs or symptoms of high blood pressure, including headaches, dizziness, blurred vision, chest pain or shortness of breath.
High blood sugar (hyperglycemia). LORBRENA may increase your blood sugar levels. Your healthcare provider should do blood tests to check your blood sugar levels before starting and during treatment with LORBRENA. Your healthcare provider may need to start or change your blood sugar medicine to control your blood sugar levels. Tell your healthcare provider right away if you get new or worsening signs and symptoms of high blood sugar, including feeling very thirsty, needing to urinate more than usual, or feeling very hungry, sick to your stomach, weak or tired, or confused.

If you have serious side effects during treatment with LORBRENA, your healthcare provider may change your dose, stop your treatment for a period of time, or completely stop treatment with LORBRENA.

Before taking LORBRENA, tell your healthcare provider about all of your medical conditions, including if you:

have kidney problems
have had episodes of depression or seizures
have high levels of cholesterol or triglycerides in your blood
have problems with your heartbeat
have lung or breathing problems
have high blood pressure
have diabetes or high blood sugar
are pregnant or plan to become pregnant. LORBRENA can harm your unborn baby.
- Your healthcare provider will do a pregnancy test before you start treatment with LORBRENA.
- Tell your healthcare provider right away if you become pregnant or think you may be pregnant during treatment with LORBRENA.
  - — Females who are able to become pregnant should use effective non-hormonal birth control during treatment with LORBRENA and for at least 6 months after the final dose of LORBRENA. Birth control pills (oral contraceptives) and other hormonal forms of birth control may not be effective if used during treatment with LORBRENA. Talk to your healthcare provider about birth control choices that are right for you during this time.
  - — Males who have female partners who are able to become pregnant should use effective birth control during treatment with LORBRENA and for at least 3 months after the final dose of LORBRENA.
are breastfeeding or plan to breastfeed. It is not known if LORBRENA passes into your breast milk. Do not breastfeed during treatment with LORBRENA and for 7 days after the final dose. Talk to your healthcare provider about the best way to feed your baby during this time.

Tell your healthcare provider about all the medicines you take, including prescription medicines, over-the-counter medicines, vitamins, and herbal supplements. LORBRENA may affect the way other medicines work and other medicines may affect the way LORBRENA works, causing side effects.

Know the medicines you take. Keep a list of them to show to your healthcare provider and pharmacist when you get a new medicine.

Do not take LORBRENA if you take certain other medicines called strong CYP3A inducers. Ask your healthcare provider for a list of these medicines if you are not sure.

The most common side effects of LORBRENA include:

swelling in your arms, legs, hands, and feet (edema)
numbness and tingling feeling in your joints or arms and legs (peripheral neuropathy)
weight gain
problems with thinking, such as forgetfulness or confusion
tiredness (fatigue)
difficulty breathing
pain in your joints
diarrhea
changes in mood, such as depression and irritability
high cholesterol and triglyceride levels in the blood
cough

LORBRENA may cause decreased fertility in males. In males, this could affect your ability to father a child. Talk to your healthcare provider if you have concerns about fertility.

These are not all of the possible side effects of LORBRENA. For more information, ask your healthcare provider or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

INDICATION

LORBRENA is a prescription medicine that is used to treat adults with non-small cell lung cancer (NSCLC) that is caused by an abnormal anaplastic lymphoma kinase (ALK) gene and that has spread to other parts of your body.

Your healthcare provider will perform a test to make sure that LORBRENA is right for you.

It is not known if LORBRENA is safe and effective in children.

Please see Full Prescribing Information and Patient Information.