Excipients:  Calcium sulfate dihydrate, Croscarmellose sodium, Magnesium stearate, Microcrystalline cellulose, Sodium bicarbonate

​

Dyes:

25 mcg: FD&C Yellow No. 6 Aluminum Lake
50 mcg: None
75 mcg: FD&C Blue No. 1 Aluminum Lake, FD&C Red No. 30 Aluminum Lake
88 mcg: FD&C Yellow No. 6 Aluminum Lake, FD&C Blue No. 1 Aluminum Lake, FD&C Yellow No. 10 Aluminum Lake
100 mcg: FD&C Yellow No. 6 Aluminum Lake, FD&C Yellow No. 10 Aluminum Lake
112 mcg: FD&C Yellow No. 6 Aluminum Lake, FD&C Red No. 40 Aluminum Lake, FD&C Red No. 30 Aluminum Lake
125 mcg: FD&C Red No. 40 Aluminum Lake, FD&C Yellow No. 10 Aluminum Lake
137 mcg: FD&C Blue No. 1 Aluminum Lake
150 mcg: FD&C Blue No. 1 Aluminum Lake, FD&C Red No. 30 Aluminum Lake
175 mcg: FD&C Blue No. 1 Aluminum Lake, FD&C Yellow No. 10 Aluminum Lake
200 mcg: D&C Red No. 30 Aluminum Lake, FD&C Yellow No. 10 Aluminum Lake

 

Typical Retail Price: $20 - $35

 

Copay Tier: 1 or 2

 

Average Copay: $11 - $33

​

Manufacturer Copay Card: Pfizer offers a copay card for Levoxyl®. The estimated savings for Levoxyl® under the program range from 36% to 75% of the retail cash price, and depend on such factors as the quantity purchased, and the pharmacy where it’s purchased. To learn more about Pfizer’s copay/savings cards to help with your copay costs for Levoxyl®, visit the Pfizer Pathways website at https://www.pfizerrxpathways.com, or call 800-364-4767

 

Manufacturer Direct Purchase Program: Not available

 

Patient Assistance Program: The Pfizer Patient Assistance Program provides eligible patients with their Pfizer medicines for free. This program is based on income and insurance coverage. You can learn more about – and apply for – the program online at https://www.pfizerrxpathways.com/start-enrollment, or call 866-706-2400
 

To Report Adverse Events to Pfizer: Call 800-438-1985, or contact Pfizer at https://www.pfizer.com/contact/email

To Report Adverse Events to FDA Medwatch: Call 800-FDA-1088, or visit the FDA Medwatch website at http://www.fda.gov/medwatch