HADLIMA^®

The patient may qualify for assistance if the following conditions apply:

• The patient is a permanent resident of the United States (inclusive of Puerto Rico and the U.S. Virgin Islands).^†
• The patient has a valid prescription for a medication offered through the Organon Patient Assistance Program.
• The patient cannot afford to pay for their medication and has a household income below 250% of the Federal Poverty Level (FPL).^‡
• The following applies to the patient with regard to insurance coverage:
  • The patient does not have commercial insurance coverage.
  • The patient must not be eligible for, enrolled in, or receiving benefits through Medicaid or Medicare Low-Income Subsidy (LIS), also known as Extra Help. Patients who have applied for either program and have been formally denied eligibility, as evidenced by written documentation from the applicable agency, may be evaluated for eligibility under the Organon Patient Assistance Program, provided all other program requirements are met. For more information on these programs, please see the FAQ page.

^†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 1-866-809-9515.

If you believe that you meet the eligibility criteria for the Organon Patient Assistance Program and you have received a prescription for HADLIMA, please download and complete the enrollment form.

Your provider will also need to complete information on this form.

Fax the completed application to 1-866-806-0775.

If fax is not available, please mail a completed application to:
Organon Patient Assistance Program
PO Box 2355
Morristown, NJ 07962

For additional assistance or if you have any questions, please call 1-866-809-9515.