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Activate Your CHANTIX Savings Card*

Please fill out the form below to activate your CHANTIX Savings Card.

Please complete the highlighted area(s)
1) Fill in the form below to activate your card. 2) Bring your card with you to the pharmacy along with a valid prescription. 3) Use your CHANTIX Savings Card for up to three purchases through June 30, 2015.
Do you purchase your prescription medication through Medicaid, Medicare or a federal or state prescription drug program?
Are you over the age of 18?

Privacy Statement Pfizer understands your personal and health information is private. The information you provide will only be used by Pfizer and parties acting on its behalf to send you the materials you requested and other helpful information and updates on Chantix as well as related treatments, products, offers, and services.

CHANTIX is covered by many insurance plans. Call your provider to find out more.