Program Details
ORGANON
Organon Access Program for Ontruzant
Ontruzant
(trastuzumab-dttb injection; iv)
|
| CONTACT
INFO |
|
| Address: |
PO Box 29035
Phoenix, AZ 85038 |
| Phone: |
1-844-326-2986 |
Provider Phone: |
|
| Fax: |
1-800-538-5812 |
Website: |
Program Website |
|
| ELIGIBILITY
|
|
| Eligibility
Info: |
Patients who do not have insurance, or who cannot afford their medicine even with prescription drug coverage, may be eligible for free product if certain financial, medical, and/or insurance criteria are met.
Program offers co-pay assistance, reimbursement support, and patient assistance programs for eligible patients. |
| |
Couple |
|
% FPL |
| Income at or below: |
Not
Published |
| Medical expenses
can be deducted from reported income: |
Not
Published |
| Social security requested on form: |
No |
| US citizenship/residency specified:
|
Yes |
|
|
APPLICATION |
|
| Attachments
Required: |
Financial
|
Physician
License #
Required: |
State
NPI
|
Prescriber
Signature
Allowed: |
Physician
|
Application
may be
faxed: |
Yes
|
Eligibility
determination
letter sent: |
Both Provider and Patient
|
|
| MEDICATION |
|
| Receives: |
Not Published
|
| Shipped To: |
Not Published
|
| Quantity in
Shipment: |
Not Published
|
| Delivery Time: |
Not Published
|
| Re-application
Policy: |
New application every 12 months
New financial information every 12 months
|
| Refill Policy: |
Patient must contact the program |
| Other Information: |
|
|
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Last Updated: 03/11/2024
www.RxAssist.org
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