FINANCIAL
ASSISTANCE

The cost for ORGOVYX may differ based on your patients' insurance coverage. How much patients pay depends on their coverage. We can help you find out what your patients' costs may be. Call 1-833-ORGOVYX (1-833-674-6899) to request an insurance benefit review.

MEDICARE

75%

of patients pay $100 or
less per month for ORGOVYX1*

MEDICAID

>80%

of patients pay
$0 a month1*

COMMERCIAL

>80%

of patients pay as
little as $10 per month1*

*Statistics represented as average costs paid per month, as of January 15, 2024. Symphony Claims Data, December 2022-November 2023. Calculated based on 30-day supply, excluding reversed, rejected, and null value claims. Data may not represent claims not captured in the Symphony dataset.

For Medicare Part D
PATIENTS

Important changes to Medicare Part D costs could impact your patients. Use this resource to find out more.

For eligible commercially insured patients

ORGOVYX® (relugolix) Copay Assistance Program Card

Pay as little as $10
per month

With the ORGOVYX Copay Assistance Program, eligible commercially insured patients pay as little as $10 per month. Learn more about the eligibility criteria for the ORGOVYX Copay Assistance Program by calling 1-833-ORGOVYX (1-833-674-6899). See Terms and Conditions below.

The ORGOVYX Support Program may be able to help those patients who are not eligible for an ORGOVYX
Savings Card or need additional assistance. Call the ORGOVYX Support Program at 1-833-ORGOVYX (1-833-674-6899).

ORGOVYX COPAY ASSISTANCE PROGRAM: TERMS AND CONDITIONS

The ORGOVYX Copay Assistance Program (“Copay Program”) is for eligible patients with commercial prescription insurance for ORGOVYX. With this Copay Program, eligible patients will pay as little as $10 per month, subject to a maximum of $10,000 per calendar year. After the annual maximum of $10,000 for ORGOVYX is reached, patient will be responsible for the remaining monthly out-of-pocket costs. This Copay Program may not be redeemed more than once per 21 days. The Copay Program is not valid for patients whose prescription claims are reimbursed, in whole or in part, by any state or federal government program, including, but not limited to, Medicaid, Medicare, Medigap, Department of Defense (DoD), Veterans Affairs (VA), TRICARE, Puerto Rico Government Insurance, or any state patient or pharmaceutical assistance program. Offer is not valid for cash-paying patients. Patient must be a resident of the U.S., Puerto Rico, or U.S. Territories. This Copay Program is void where prohibited by state law and on the date an AB generic equivalent for ORGOVYX becomes available. Certain rules and restrictions apply. This offer is not insurance. This offer cannot be combined with any other coupon, free trial, discount, prescription savings card, or other offer. This offer is not conditioned on any past, present, or future purchase, including refills. Patient and participating pharmacists agree not to seek reimbursement for all, or any part of the benefit received by the patient through this Copay Program. Patient and participating pharmacists agree to report the receipt of Copay Program benefits to any insurer or other third party who pays for or reimburses any part of the prescription filled using the Card, as may be required by such insurer or third party. Sumitomo Pharma America reserves the right to revoke, rescind, or amend this offer without notice. The ORGOVYX Copay Program is valid through December 31, 2024.

ORGOVYX NATIONAL COVERAGE
99% of Medicare patients are covered for ORGOVYX with no step therapy
92% of commercial patients are covered for ORGOVYX
 
SEE FORMULARY COVERAGE
IN YOUR AREA

This coverage information is provided for informational purposes only; individual plans vary, and this may not include all plans. Sumitomo Pharma America and Pfizer make no representation or guarantee concerning coverage or reimbursement for ORGOVYX; please check with individual payers for plan-specific coverage and reimbursement information and requirements. Nothing herein may be construed as an endorsement, approval, recommendation, representation, or warranty of any kind by any plan or insurer referenced. This information is subject to change without notice. Data on file. Formulary data are provided by MMIT, LLC, as of May 2024. Transaction data are provided by SHS database as of May 2024.