Before prescribing ONTRUZANT, please read the accompanying
Prescribing Information, including the Boxed Warning about cardiomyopathy,
infusion reactions (pulmonary toxicity), and embryo-fetal toxicity.
RESOURCES
CoverMyMeds Portal
CoverMyMeds gives health care providers the opportunity to electronically enroll patients into The Organon Access Program or electronically initiate other access services like prior authorizations.
CoverMyMeds User Guide
Training resource guide intended to assist with any actions required by health care providers and/or provider office staff.
CoverMyMeds Cases Material
Brochure highlighting capabilities of Cases available in your CoverMyMeds account.
The Organon Access Program uses services and technology provided by CoverMyMeds.
The Organon Access Program Enrollment Form
Download this form to fill out, print, and fax.
The Organon Access Program Sample Enrollment Form
Representative’s Form
Potential Independent Foundation Support
Biosimilars Reimbursement Flashcard
Prior Authorization Checklist
Sample Prior Authorization Letter
Appeal Checklist
Sample Appeal Letter
Co-pay Claims Portal
Medical co-pay claims can be submitted electronically using the Co-pay Claims Portal.
Electronic Billing Guide
Sample CMS-1500 Form
Sample UB-04 Form
Visit the health care professional website for ONTRUZANT.
Physician Prescribing Information
The information available here is compiled from sources believed to be accurate, but Organon makes no representation that it is accurate. This information is subject to change. Payer coding requirements may vary or change over time, so it is important to regularly check with each payer as to payer-specific requirements.
The information available here is not intended to be definitive or exhaustive, and is not intended to replace the guidance of a qualified professional advisor. Organon and its agents make no warranties or guarantees, express or implied, concerning the accuracy or appropriateness of this information for your particular use given the frequent changes in public and private payer billing. The use of this information does not guarantee payment or that any payment received will cover your costs.
You are solely responsible for determining the appropriate codes and for any action you take in billing. Information about HCPCS codes is based on guidance issued by the Centers for Medicare & Medicaid Services applicable to Medicare Part B and may not apply to other public or private payers. Consult the relevant manual and/or other guidelines for a description of each code to determine the appropriateness of a particular code and for information on additional codes. Diagnosis codes should be selected only by a health care professional.
Abbreviation: HCPCS, Healthcare Common Procedure Coding Systems.
