Please confirm that the person signing up:
  • Is 18 years of age or older, and
  • Currently lives in the United States or​​​​​​ Puerto Rico
You are eligible to sign up below for CIBINQO support emails, with helpful tools and tips!
 
       •     At this time, we are sorry to confirm that you are not eligible to receive a CIBINQO Copay Savings Card. You must be 18 years of age or older and a resident of the U.S. or Puerto Rico to enroll.
​​​​​​​

Please complete the form below and click Sign me up to enroll for support emails now.

Please confirm if any of the following statements are true for the person signing up:

  • They have insurance from a federal healthcare program (including Medicare, Medicaid, TRICARE, or any other state or federal medical pharmaceutical benefit program or pharmaceutical assistance program)
  • They, or their partner (if applicable), are over 65 years of age and retired
  • They receive Social Security Disability Insurance (SSDI) or any other Social Security Administration (SSA) benefit​​​​​
  • They receive health insurance through the military

We’re sorry, more information is needed before we can confirm your Copay Savings Card eligibility.

Please call 1-833-956-DERM (1-833-956-3376) to speak with a Patient Support Representative, then enroll and activate your card, if eligible.

You are still eligible to sign up for CIBINQO information with helpful tools and tips. Please click Sign me up to enroll.

*Eligibility required. No membership fees. This is not health insurance. For CIBINQO, the maximum benefit per patient is $15,000 per calendar year. Only for use with commercial insurance. If you are enrolled in a state or federally funded prescription insurance program, you may not use the copay card. Terms and Conditions apply.

By checking this box, I confirm that I am eligible to participate in this program and agree to the Terms and Conditions specified here. Please agree to the Terms and Conditions before proceeding. If you have questions relating to your eligibility for Pfizer Dermatology Patient Access, you can contact 1-833-956-DERM (1-833-956-3376) and provide your commercial insurance information to verify eligibility.

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Pfizer understands that your personal and health information is private and will only use your information in accordance with our Privacy Policy. The information you provide will only be used by Pfizer and parties acting on its behalf to send you the materials you requested as well as other helpful product and/or related product information, disease state information, offers, and services.

Enter your card ID# (12 characters containing letters and numbers).

Pay as little as $0 for CIBINQO™ (abrocitinib) with the Copay Savings Card

Eligibility required. No membership fees. This is not health insurance. For CIBINQO, the maximum benefit per patient is $15,000 per calendar year. Only for use with commercial insurance. If you are enrolled in a state or federally funded prescription insurance program, you may not use the copay card. Terms and Conditions apply

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I'd like to receive text messages regarding my Copay Savings Card and additional CIBINQO information (optional)

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Mobile terms and conditions apply. Msg & data rates may apply. Msg frequency varies. Text HELP for info, STOP to opt out. Pfizer's privacy policy can be found at Pfizer.com/privacy.

*Eligibility required. No membership fees. This is not health insurance. For CIBINQO, the maximum benefit per patient is $15,000 per calendar year. Only for use with commercial insurance. If you are enrolled in a state or federally funded prescription insurance program, you may not use the copay card. Terms and Conditions apply.

Privacy Statement

Pfizer understands that your personal and health information is private and will only use your information in accordance with our Privacy Policy. The information you provide will only be used by Pfizer and parties acting on its behalf to send you the materials you requested as well as other helpful product and/or related product information, disease state information, offers, and services.

Which best describes the person who’s signing up:

Privacy Statement

Pfizer understands that your personal and health information is private and will only use your information in accordance with our Privacy Policy. The information you provide will only be used by Pfizer and parties acting on its behalf to send you the materials you requested as well as other helpful product and/or related product information, disease state information, offers, and services.