Polivy

(polatuzumab vedotin)
polatuzumab vedotin-piiq 140 MG Injection [Polivy]polatuzumab vedotin-piiq 30 MG Injection [Polivy]
NO BLACK BOX WARNING

Dosage & administration

biomarker testing

Polivy clinical details

Genetic testing requirements were obtained from the NCCN guidelines for each cancer type.

drug label

Polivy prescribing information

prior authorization

Polivy prior authorization resources

Most recent Polivy prior authorization forms

View By Payer
Verified: Sep 28, 2023Cigna - Polivy Prior Authorization Form
Verified: Sep 21, 2023Aetna - Polivy Prior Authorization Form
Verified: Sep 21, 2023Aetna - Medicare Part B Polivy Prior Authorization Form

OTHER
Complete Letter of Medical Necessity

OTHER
Coverage Authorization Appeals
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Benefits investigation

Phesgo Prescriber Service Form - Online Portal
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pharmacy

Polivy preferred pharmacy

OTHER
Pharmacy List

financial assistance

Polivy financial assistance options

Co-pay savings program

commercial only
Phesgo Prescriber Service Form - Online Portal
Enroll in Patient Savings Program
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Foundation programs

under insured
no insurance
goverment insurance
65+
Phesgo Prescriber Service Form - Online Portal

PDF
Genentech Patient Foundation Application Form (1/2)
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patient education

Polivy patient education

Getting started on Polivy

To share resource; ask patient to:
1.Pull out phone
2.Open camera
3.Scan QR code with camera
4.Tap link

Patient toolkit

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

BRAND PAGE
About Polivy
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

BRAND PAGE
Side Effects
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

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

OTHER
Preparing For Infusion
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

OTHER
Patient Resources
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
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Other resources

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people also ask

Polivy FAQs

How is the dosage of Polivy?Polivy is available in 2 dosages, including 140 mg Injection and 30 mg Injection
What does Polivy treat?Polivy treats Diffuse Large B-Cell Lymphoma
How Is Polivy Administered?Polivy is administered as a Injectable
FAQ Data Source