Whilst Pfizer will provide IBRANCE (palbociclib) at no charge if the patient is eligible, dispensing charges may apply from the nominated pharmacy, which is beyond Pfizer’s control.
In the event that personal information is shared with Pfizer, it will be collected and used in accordance with Pfizer Australia’s privacy policy available at Pfizer.com.au/privacy.
You can view Pfizer’s Privacy Policy by visiting http://www.pfizer.com.au
Pfizer has the right to stop/alter this program at any time. Reasonable notice will be provided in advance of any changes to this program.
- You have received and read a copy of the IBRANCE (palbociclib) Product Information
- You agree to explain the IBRANCE Patient Assistance Program to patients in sufficient detail to enable informed consent
- You have read and understood the Privacy statement and agree with it
- You understand that you are required to provide your patient’s proof of purchases for IBRANCE from an Australian pharmacy and de-identify your patient’s details
- After confirming patient eligibility and providing sufficient proof of purchases, your patient will receive IBRANCE at no charge (dispensing charge may apply from the nominated pharmacy). Pfizer will continue to supply IBRANCE until further notice. Pfizer reserves the right to change the terms and conditions of this program at any time
- If you report an adverse event, with your consent, your personal information will be provided to Pfizer and Pfizer may need to contact you for more information – personal information will be used by Pfizer in accordance with its privacy policy at www.pfizer.com.au/cookie-privacy-policy