The Organon Access Program for RENFLEXIS® (infliximab-abda)
Please read the Medication Guide for RENFLEXIS, including the information about serious infections and cancers, and discuss it with your doctor. The physician Prescribing Information also is available.

WELCOME TO

THE ORGANON ACCESS PROGRAM

ARE YOU A US HEALTH CARE PROFESSIONAL?
YES
NO

ENROLL NOW

Please click on the links below to access The Organon Access Program forms that are applicable to you. If you are requesting a referral to the Organon Patient Assistance Program, be sure to include all information, including a prescription from your health care provider for RENFLEXIS. Please be sure all signatures are included prior to submitting forms to The Organon Access Program.

Download and Print the RENFLEXIS® (infliximab-abda) Enrollment Form

DOWNLOAD & PRINT

This form can be downloaded and printed, and requires an original signature. Work with your health care provider to complete the enrollment form.

  2022 Enrollment Form

Use this form to re-enroll in The Organon Access Program.

Electronically Sign and Submit the RENFLEXIS® (infliximab-abda) 2021 Enrollment Form

SIGN & SUBMIT ELECTRONICALLY

This patient form can be signed and submitted electronically. Please note that your health care provider must also submit the Health Care Provider Enrollment Form.

 2022 Electronic Patient Enrollment Form

ENROLLMENT ASSISTANCE

Sample Enrollment Form

Download and use this form as a guide for completing the enrollment form.


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