Dosage & Administration Drug label Prior authorization Financial assistance

Orilissa

(elagolix)

elagolix 150 MG Oral Tablet [Orilissa]elagolix 200 MG Oral Tablet [Orilissa]

NO BLACK BOX WARNING

Dosage & administration

Normal liver function or mild hepatic impairment: 150 mg once daily for up to 24 months or 200 mg twice daily for up to 6 months.

Moderate hepatic impairment: 150 mg once daily for up to 6 months.

Orilissa prescribing information

Have more Orilissa questions?

Submit MSL Request

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Need to report an Orilissa issue?

ONLINE FORMReport adverse event

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prior authorization

Orilissa Prior authorization resources

Complete Letter of Medical Necessity

NOT PROVIDED BY BRANDCoverage Authorization Request

Coverage Authorization Appeals

Prior Authorization Guide

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Benefits investigation

NOT PROVIDED BY BRANDBenefits investigation resources

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Reimbursement help (FRM)

Receive Assistance from an FRM Regarding Reimbursement Information

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financial assistance

Orilissa Financial assistance options

Co-pay savings program

commercial only

Enroll in Patient Savings Program

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Overview

Reduce patient OOP costs for drug (and occasionally for drug administration/infusion costs or drug-related test costs)

Patient benefit

A portion (or all) of patient OOP (deductible, copay), typically up to monthly and/or annual max

Patient eligibility

Patient must enroll or activate (may permit HCPs to enroll on patient’s behalf for HCP-administered drugs)
Generally, must have commercial insurance (rarely, may permit uninsured patients to use)
May never be used with government insurance

How to sign up

Cards may be downloadable digital cards or hard copies
Some pharmacos offer debit cards with pre-loaded copay benefit
Typically, available through multiple channels (e.g., rep to HCP to patient; pharmacy to patient; patient via website, Hub live agent, or copay vendor (live agent or IVR); patient and HCP via Hub enrollment form)
Some HCP-administered product programs permit HCPs to enroll on a patient’s behalf through via Hub form

Bridge program

commercial only

Enroll in Bridge Program

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Overview

Provide patient immediate access to therapy during an insurance delay (typically new starts; some may cover change in insurance)
Limited time/ fill (typically 7-30 days; some may offer additional fill for continued delay up to certain limit)

Patient benefit

100% free (outside of insurance)

Patient eligibility

HCP must enroll patient
May be limited to commercially insured patients (i.e., no government beneficiaries); some programs may allow government beneficiaries

How to sign up

Typically HCP assisted enrollment (via form)

Foundation programs

under insured

no insurance

goverment insurance

65+

Orilissa Patient Assistance Program Application - English

Orilissa Patient Assistance Application - Spanish

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Overview

Charitable 501(c)(3) organizations provide direct cost-sharing and other support (e.g., travel, counseling) through disease-state funds to indigent patients on first-come first-served basis
These organizations may receive financial contributions from drug manaufacturers for particular disease-state funds that cannot provide funds directly to patients - the foundation must be independent/unaligned

Patient benefit

Patients apply for grants that cover a portion (or all) of their out-of-pocket costs (deductibles and co-pays) until the grant is exhausted

Patient eligibility

Patients must apply and meet eligibility criteria including income level (typically a multiple of federal poverty line), specific diagnosis, insurance status, etc.

How to sign up

Patients submit proof of out-of-pocket drug costs to charities for reimbursement

patient education

Orilissa Patient education

Getting started on Orilissa

NOT PROVIDED BY BRANDInstructions For Use - Moderate to Severe Pain due to Endometriosis

Patient toolkit

Patient Brochure

ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

About Orilissa

ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

Patient Stories

ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

Learn More

Orilissa FAQs

FAQ Data Source

Can't find what you're looking for?

Our trained staff can help you:

Please note:

Access to a Field Reimbursement Manager (FRM) or Medical Science Liaison (MSL) varies by brand and may require talking with your rep first.
Samples are provided at the discretion of the brand.
We are unable to collect Protected Health Information (PHI), fill out forms, or submit them on your behalf.

Orilissa

Dosage & administration

Most viewed Orilissa resources

drug label

Orilissa prescribing information

Have more Orilissa questions?

Need to report an Orilissa issue?

prior authorization

Orilissa Prior authorization resources

Benefits investigation

Reimbursement help (FRM)

financial assistance

Orilissa Financial assistance options

Co-pay savings program

Overview

Patient benefit

Patient eligibility

How to sign up

Bridge program

Overview

Patient benefit

Patient eligibility

How to sign up

Foundation programs

Overview

Patient benefit

Patient eligibility

How to sign up

patient education

Orilissa Patient education

Getting started on Orilissa

Patient toolkit

people also ask

Orilissa FAQs

Can't find what you're looking for?