Enroll Now
If your patient is requesting a referral to the Organon Patient Assistance Program, be sure to include all information, including a prescription for TOFIDENCE, which you can now complete on the enrollment form. Please be sure all signatures are included prior to submitting forms to The Organon Access Program.
Download this form to fill out, print, and fax
For help submitting this form, call the Organon Access Program 1-855-635-9581.
Before prescribing TOFIDENCE, please read the accompanying Prescribing Information, including the Boxed Warning about serious infections. The Medication Guide also is available.