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Copay savings program

Program Terms and Conditions

  • Provides copay/coinsurance support for eligible patients with private commercial insurance only.*
  • Program covers up to $500 of out-of-pocket copay/coinsurance costs after the patient has paid the first $50 of their required copay/coinsurance amount.
  • Copay/coinsurance support is available to cover patient out-of-pocket costs associated with treatments of ORBACTIV® administered in a physician practice based infusion clinic, hospital outpatient setting or home infusion. The program is not available for treatments of ORBACTIV® administered in the inpatient hospital setting of care.
  • The program does not cover any deductible amounts that may be owed by a patient.

Explanation of Payment document must be submitted to 1-844-ORBACTIV to demonstrate patient eligibility.

*Patients must be United States residents and be 18 years of age or older. Eligible patients must have a minimum of a $50 copayment or coinsurance obligation for ORBACTIV®. Patients will be granted up to $500 of copay savings funds and must contribute $50 toward their copay or coinsurance. The Program does not cover deductible, premium, or other amounts that are not exclusively stated as copayment or coinsurance. Patients who pay cash or who are enrolled in or participate in any type of government insurance or reimbursement programs, including but not limited to Medicare, Medicaid, including managed Medicaid, Tricare, and FEHP, are not eligible. As a condition precedent of the copayment or coinsurance support provided under this program, e.g., copay or coinsurance amounts paid to administering providers, participating patients and administering providers are obligated to inform insurance companies and third-party payors of any benefits they receive and the value of this program, as required by contract or otherwise. Void where prohibited by law, taxed, or restricted. Additional terms and conditions may apply. Patients enrolled in the ORBACTIV® Patient Assistance Program are not eligible. Melinta Therapeutics, Inc. may determine eligibility, monitor participation, and modify or discontinue any aspect of this program at any time. For additional information regarding ORBACTIV®, including Important Safety Information, please see the Full Prescribing Information available at www.orbactiv.com.

For assistance, please call the Copay Savings Program:

1-844-ORBACTIV (1-844-672-2284) Monday - Friday, 8:00 AM - 8:00 PM ET

orbactivassistanceprogram@themedco.com
www.orbactiv.com


To download the ORBACTIV® Physician/Patient Assistance Form, please click the PDF file below

Orbactiv® (oritavancin) for injection patient assistance form

DISCLAIMER

Content provided for informational purposes only. This information does not guarantee coverage or payment. Codes, coverage, and payment may vary from setting to setting, and from insurer to insurer. The provider submitting a claim is solely responsible for the accuracy of the codes submitted and for compliance with all coverage and reimbursement policies.

Decisions to prescribe ORBACTIV® are by providers working with their patients. The ORBACTIV® Assistance Program provides information about ORBACTIV® and about assistance that may be available to patients who meet certain criteria, including that they are not insured by a federal health care program. More information is available through the ORBACTIV® Assistance Program.

Melinta Therapeutics, Inc. does not guarantee, and assumes no responsibility for the quality, availability, or scope of the ORBACTIV® Assistance Program services. Melinta Therapeutics, Inc. reserves the right to rescind, revoke, or amend this offer at any time without notice. Void where prohibited by law.

INDICATION

ORBACTIV® (oritavancin) is indicated for the treatment of adult patients with acute bacterial skin and skin structure infections (ABSSSIs) caused or suspected to be caused by susceptible isolates of the following Gram-positive microorganisms: Staphylococcus aureus (including methicillin-susceptible [MSSA] and -resistant [MRSA] isolates), Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus dysgalactiae, Streptococcus anginosus group (includes S. anginosus, S. intermedius, and S. constellatus), and Enterococcus faecalis (vancomycin-susceptible isolates only).

Important Safety Information

Contraindications

Use of intravenous unfractionated heparin sodium is contraindicated for 120 hours (5 days) after ORBACTIV® administration because the activated partial thromboplastin time (aPTT) test results are expected to remain falsely elevated for approximately 120 hours (5 days) after ORBACTIV® administration.

ORBACTIV® is contraindicated in patients with known hypersensitivity to ORBACTIV®.

Warnings and Precautions

Coagulation test interference: ORBACTIV® has been shown to artificially prolong aPTT for up to 120 hours, and may prolong PT and INR for up to 12 hours, and ACT for up to 24 hours. ORBACTIV has also been shown to elevate D-dimer concentrations up to 72 hours.

Hypersensitivity reactions have been reported with the use of antibacterial agents including ORBACTIV®. Discontinue infusion if signs of acute hypersensitivity occur. Monitor closely patients with known hypersensitivity to glycopeptides.

Infusion Related Reactions: Administer ORBACTIV® over 3 hours to minimize infusion-related reactions. Stopping or slowing the infusion may result in cessation of these reactions.

Clostridium difficile-associated diarrhea: Evaluate patients if diarrhea occurs.

Concomitant warfarin use: ORBACTIV has been shown to artificially prolong PT and INR for up to 12 hours. Patients should be monitored for bleeding if concomitantly receiving ORBACTIV® and warfarin.

Osteomyelitis: Institute appropriate alternate antibacterial therapy in patients with confirmed or suspected osteomyelitis.

Prescribing ORBACTIV® in the absence of a proven or strongly suspected bacterial infection is unlikely to provide benefit to the patient and increases the risk of development of drug-resistant bacteria.

Adverse Reactions

The most common adverse reactions (≥3%) in patients treated with ORBACTIV® were headache, nausea, vomiting, limb and subcutaneous abscesses, and diarrhea.

See Full Prescribing Information

INDICATION

ORBACTIV® (oritavancin) is indicated for the treatment of adult patients with acute bacterial skin and skin structure infections (ABSSSIs) caused or suspected to be caused by susceptible isolates of the following Gram-positive microorganisms: Staphylococcus aureus (including methicillin-susceptible [MSSA] and -resistant [MRSA] isolates), Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus dysgalactiae, Streptococcus anginosus group (includes S. anginosus, S. intermedius, and S. constellatus, and Enterococcus faecalis (vancomycin-susceptible isolates only).

www.orbactiv.com

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