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THE ORGANON ACCESS PROGRAM

ARE YOU A US HEALTH CARE PROFESSIONAL?
The Organon Access Program for RENFLEXIS® (infliximab-abda)
RENFLEXIS® (infliximab-abda) for injection, for intravenous use 100 mg
Physician Prescribing Information Medication Guide
Health Care Professionals Patients and Caregivers
Medication Guide Physician Prescribing Information
The Organon Access Program for RENFLEXIS® (infliximab-abda)
Before prescribing RENFLEXIS, please read the accompanying Prescribing Information, including the Boxed Warning about serious infections and malignancies. The Medication Guide also is available.
RENFLEXIS® (infliximab-abda) for injection, for intravenous use 100 mg
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ENROLL NOW
Contact The Organon
Access Program at 866-847-3539
Mon-Fri 8 AM to 8 PM ET

ENROLL NOW

Please review the enrollment options below to access The Organon Access Program and choose the method that best works for you and your patient. If your patient is requesting a referral to the Organon Patient Assistance Program, be sure to include all information, including a prescription for RENFLEXIS, which you can now complete on the enrollment form. Please be sure all signatures are included prior to submitting forms to The Organon Access Program.

Option
1

Electronic Enrollment
via CoverMyMeds

Click to enroll

Allows health care providers to electronically enroll patients into
The Organon Access Program and initiate other access services.

With CoverMyMeds, you can:

  • Perform benefits investigations and submit prior authorizations
  • Access the Organon Co-pay Assistance Program
  • Track patient case status
  • Submit prescriptions

Option
2

Download,
Print & Fax

ENROLLMENT FORM

Download this form to fill out, print and fax.

Patients can sign and submit the enrollment form electronically using DocuSign.

Looking for the DocuSign Provider and Patient Enrollment Form? Option 1 (Electronic Enrollment) replaced that form.
For help submitting that form via CoverMyMeds, call 866-847-3539.

Sample
ENROLLMENT FORM

ENROLLMENT ASSISTANCE

Use this form as a guide for completing the enrollment form.

Option 1

Electronic Enrollment
via CoverMyMeds

Click to enroll

Allows health care providers to electronically enroll patients into The Organon Access Program and initiate other access services.

With CoverMyMeds, you can:

  • Perform benefits investigations and submit prior authorizations
  • Access the Organon Co-pay Assistance Program
  • Track patient case status
  • Submit prescriptions

Option 2

Download, Print & Fax

ENROLLMENT FORM

Download this form to fill out, print and fax.

Patients can sign and submit the enrollment form electronically using DocuSign.

Looking for the DocuSign Provider and Patient Enrollment Form? Option 1 (Electronic Enrollment) replaced that form.
For help submitting that form via CoverMyMeds, call 866-847-3539.

ENROLLMENT ASSISTANCE

SAMPLE
ENROLLMENT FORM

Use this form as a guide for completing the
enrollment form.

This site is intended only for residents of the United States.
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