RENFLEXIS^®

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.

To apply for the Organon Patient Assistance Program for RENFLEXIS, please work with your health care provider to complete an enrollment form for The Organon Access Program. The Organon Access Program can also provide support to help answer questions related to insurance coverage and reimbursement.

To access the enrollment form, click here.

You and your health care provider can also call The Organon Access Program at 1-866-809-9515 if you need assistance. The Organon Access Program representatives are available Monday through Friday, 8 AM to 8 PM ET, to answer questions about the program.