File a Claim
IMPORTANT: The Settlement Administrator may request supporting purchase documentation in addition to the documentation and information requested below, so please retain all purchase records. The Settlement Administrator may reject a claim if the Class Member or their authorized agent does not provide all requested documentation in a timely manner.
Individual Consumers
If you are a member of the Class as a consumer, you may file a claim for a pro rata share of the Settlement Fund. You must complete a Claim Form and mail it to the Settlement Administrator, or submit your claim online by September 14, 2026, through the link below.
To file your Consumer Claim online, click the button below:
To file your claim by mail, download a copy of the Consumer Claim Form here
Third-Party Payors (TPPs)
Third Party Payors (TPPs) are entities (besides the patient) that provide payment or reimbursement for health care expenses, like prescription drug benefits. They include entities such as, self-insured health and welfare plans and health insurance companies that make payments from their own funds, and other health benefit providers and entities with self-funded plans that contract with a pharmacy benefit manager (PBM) or administrator to administer their prescription drug benefits for their members, employees, insureds, participants, or beneficiaries.
TPP Claim Forms must be postmarked (if mailed) or received (if submitted online) no later than September 14, 2026.
To file your TPP Claim online, click the button below:
To file your claim by mail, download a copy of the TPP Claim Form here
To download the Chantix TPP Filing Template, click here
To download the eligible Chantix NDC list, click here
Note: These documents are in PDF format. To view the
documents, you will need Adobe Acrobat Reader on your computer or other internet-enabled device.
