FORMULARY
LOOKUP TOOL

See your local coverage information in the plan table below.
99% of Medicare
patients are
covered for
ORGOVYX*
94% of commercial
patients are
covered for
ORGOVYX*

*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 February, 2023. Transaction data are provided by SHS database as of January, 2023.

Understanding PA requirements
after you prescribe ORGOVYX

When you prescribe ORGOVYX for the treatment of advanced prostate cancer, fill the prescription the way you normally do. Your patient's health plan may require a PA before coverage is approved for ORGOVYX. In such cases, the patient's health plan has certain requirements that must be met to determine whether the medication is covered for the particular patient. Inside this resource, healthcare providers can find information regarding:

Lightbulb icon

CONSIDERATIONS FOR SUBMITTING A PA

Magnifying glass icon

ICD-10-CM CODE
INFORMATION

Checklist icon

EXAMPLES OF PA CRITERIA
FOR ORGOVYX

Click for more information about PA