Merrimack

Featured Drug Company Program


Merrimack PROVYDE: Onivyde Access Services

844-664-8933
www.onivyde.com/onivyde-access-services

Merrimack Pharmaceuticals offers an array of patient support services and reimbursement services to facilitate patient access to Onivyde (irinotecan liposome injection) through PRO­VYDE (Onivyde Access Services).

Onivyde is indicated, in combination with fluorouracil and leuco­vorin, for the treatment of patients with metastatic adenocarcinoma of the pancreas after disease progression following Gemzar (gemcitabine)-­based therapy (Table).

Table Merrimack Oncology Drugs
Drug Indications Patient support programs Contact information
Onivyde
(irinotecan liposome injection)
Metastatic pancreatic cancer, in combination with fluorouracil + leucovorin, when disease progresses after gemcitabine-based therapy PROVYDE $0 Commercial Copay Program www.onivyde.com/onivyde-access-services
PROVYDE Patient Assistance Program

PROVYDE includes $0 commercial copay program; patient assistance program; assistance with insurance veri­fication; referrals to independent, non­profit organizations for federally insured patients; and referrals for travel assistance.

PROVYDE can also support healthcare providers in submitting claims for Onivyde by contacting the payer to confirm that the claim submission was processed correctly, tracking claims until a decision is rendered and relaying results to the provider, and helping the provider’s office troubleshoot any denied or rejected claims.

Eligibility

$0 Commercial Copay Program

The $0 Commercial Copay Program assists eligible commercially insured patients by reducing their out-of-pocket prescription costs.

To be eligible for this program, patients must:

  • Be treated in the United States or the US territories
  • Have commercial insurance that covers Onivyde and its associated costs
  • Be prescribed Onivyde for an FDA-approved indication
  • Have an annual income of 400% of the federal poverty level, and have supporting income documentation, such as the most recent US income tax return (IRS Form 1040), most recent Social Security income statement (SSA-1099), most recent pay stub, or a notarized letter stating patient has no annual income
  • Not be enrolled in federal- or state-subsidized healthcare programs that cover their prescription drugs, such as Medicare, the Medicare Part D prescription drug benefit, Medicaid, TRICARE, or any other federal or state healthcare plan, including pharmaceutical assistance programs.
Application for the program will be determined on a case-by-case basis.

Patient Assistance Program

The Patient Assistance Program assists the uninsured and the functionally uninsured. To be eligible for this program, patients must:

  • Be treated in the United States or the US territories
  • Be uninsured or functionally un­insured
  • Be prescribed Onivyde for an FDA-approved indication
  • Have a financial hardship
  • Have an annual income of 400% of the federal poverty level and have documentation, such as the most recent US income tax return (IRS Form 1040), most recent Social Security income statement (SSA-1099), most recent pay stub, or a notarized letter stating patient has no annual income.
Application for the program will be determined on a case-by-case basis

.

Enrollment

Patients can enroll in PROVYDE by completing the Start Form (available at www.onivyde.com/_assets/pdf/PROVYDE_Start_Form.pdf) and faxing it to 844-269-3039 or mailing it to the address on the form.

The services requested can be indicated on the application form and the appropriate sections can be completed. Sections 1, 2, 3, and 4 on page 1 must be completed for insurance verification; referral to an independent, nonprofit organization; and referral for travel assistance.

PROVYDE will acknowledge receipt of the application, initiate the requested services, relay all results to the physician’s office, and confirm the next steps.

Receiving Onivyde

Merrimack has contracted with a network of authorized specialty distributors to provide service to customers who purchase Onivyde, including ASD Healthcare, Cardinal, McKesson Plasma and Biologics, McKesson Specialty, and Oncology Supply.