Who May Qualify
If you have been prescribed an Organon medicine, you may be eligible for the program* if all 3 of the following conditions apply:
You are a US resident and have a prescription for an Organon product from a health care provider licensed in the United States.†
AND
You do not have insurance or other coverage for a prescription medicine.
AND
You cannot afford to pay for your medicine. You may qualify for the patient assistance program if you have a household income of $72,900 or less for individuals, $98,600 or less for couples, or $150,000 or less for a family of 4.‡
Referrals from The Organon Access Program to the Organon Patient Assistance Program are primarily designed to help those who do not have insurance coverage; however, if you have insurance coverage, but still are having trouble paying for your medicine, you may still be eligible, provided that your income is not above a set limit and you meet certain other medical and/or insurance criteria.
* Offered through the Organon Patient Assistance Program Inc.
† You do not have to be a US citizen. Legal residents of the United States, including US Territories, are also eligible.
‡ For income limits in Alaska and Hawaii, please call 888-727-0015.
How to Get Started
To apply for the Organon Patient Assistance Program for ONTRUZANT, you must complete an Enrollment Form for The Organon Access Program. The Organon Access Program provides support to help answer questions related to insurance coverage and reimbursement.
You and your health care provider can call The Organon Access Program at 844-326-2986 to request an enrollment form. The Organon Access Program Representatives are available 8 AM to 8 PM ET, Monday through Friday, to answer questions about the program.
Check Your Eligibility
Download Enrollment Form (Application)
To access the enrollment form for ONTRUZANT, click here.