Polivy

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

Dosage & administration

drug label

Polivy prescribing information

Have more Polivy questions?

Submit MSL Request
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Need to report a Polivy issue?

ONLINE FORM
Report adverse event
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samples

Request Polivy samples

NOT PROVIDED BY BRAND
View Online Sample Form
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prior authorization

Polivy Prior authorization resources

Complete Letter of Medical Necessity

NOT PROVIDED BY BRAND
Coverage Authorization Request
Coverage Authorization Appeals
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Benefits investigation

Phesgo Prescriber Service Form - Online Portal
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Reimbursement help (FRM)

NOT PROVIDED BY BRAND
Reimbursement help (FRM) resources
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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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Bridge program

commercial only
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Foundation programs

under insured
no insurance
goverment insurance
65+
Phesgo Prescriber Service Form - Online Portal
Genentech Patient Foundation Application Form (1/2)
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patient education

Polivy Patient education

Getting started on Polivy

NOT PROVIDED BY BRAND
Instructions For Use: Large B-cell Lymphoma

Patient toolkit

Patient Brochure
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
About Polivy
ASK PATIENT TO:
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Side Effects
ASK PATIENT TO:
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Scan QR Code & Tap Link
Receiving Polivy
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Preparing For Infusion
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Patient Resources
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Learn More

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.