Orgovyx Patient Assistance Program

Funded

About

The Orgovyx Patient Assistance Program offers significant benefits for eligible patients, allowing them to access the drug product Orgovyx potentially at no cost. This program is designed to help patients who have no insurance or inadequate coverage for Orgovyx, ensuring they receive the medication they need. The Orgovyx Patient Assistance Program requires patients and prescribers to complete the enrollment form, and participation involves annual re-evaluation and re-enrollment. For those meeting eligibility criteria, including government health insured patients, the program provides Orgovyx free for the entire coverage year.

Insurance requirements: Medicare / Medicaid, Underinsured, Uninsured

Enrollment Forms

Enrollment Form

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: Yes

•Activation Required: No

Program Details

•Eligible patients may be able to get ORGOVYX at no cost.

•Patients and prescribers must complete the ORGOVYX Support Program enrollment form and fax completed form to 8448268875

•Program requires annual reevaluation and reenrollment for continued participation

•Patients may be asked to reverify insurance coverage status during the course of the program

•Government health insured patients who meet the program eligibility criteria are eligible to receive free ORGOVYX for the entire coverage year

•Call 8336746899, MondayFriday, 8 am8 pm ET, for more information

Enrollment Forms

Enrollment Form