What 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

What is Polivy made of?

Polivy contains polatuzumab vedotin which is a undefined

How is Polivy administered?

Polivy is administered as a Injectable

Dosage & Administration Drug label Samples Prior authorization Financial assistance

Patient education

Polivy

(polatuzumab vedotin)

polatuzumab vedotin-piiq 140 MG Injection [Polivy]polatuzumab vedotin-piiq 30 MG Injection [Polivy]

NO BLACK BOX WARNING

Dosage & administration

* The recommended dose of POLIVY is 1.8 mg/kg as an intravenous infusion over 90 minutes every 21 days for 6 cycles in combination with bendamustine and a rituximab product. Subsequent infusions may be administered over 30 minutes if the previous infusion is tolerated.
* Premedicate with an antihistamine and antipyretic before POLIVY.
* See Full Prescribing Information for instructions on preparation and administration.

drug label

Polivy prescribing information

Have more Polivy questions?

Submit MSL Request

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Need to report a Polivy issue?

ONLINE FORMReport adverse event

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samples

Request Polivy samples

NOT PROVIDED BY BRANDView Online Sample Form

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prior authorization

Polivy Prior authorization resources

Complete Letter of Medical Necessity

NOT PROVIDED BY BRANDCoverage Authorization Request

Coverage Authorization Appeals

Patient Consent Form

Patient Consent Form - Spanish

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Benefits investigation

Polivy Prescriber Service & Patient Consent Form

Phesgo Prescriber Service Form - Online Portal

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Reimbursement help (FRM)

NOT PROVIDED BY BRANDReimbursement help (FRM) resources

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financial assistance

Polivy Financial assistance options

Co-pay savings program

commercial only

Polivy Prescriber Service & Patient Consent Form

Phesgo Prescriber Service Form - Online Portal

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

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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+

Polivy Prescriber Service & Patient Consent Form

Phesgo Prescriber Service Form - Online Portal

Genentech Patient Foundation Application Form (1/2)

Genentech Patient Foundation Application Form (2/2) - Patient Consent Form

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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

Polivy Patient education