Patient Benefit Investigation and Prescription Order

Scenario: When both support options are checked on the Enrollment Form, a patient benefit investigation will be completed, and if coverage is available under the patient’s pharmacy benefit, the prescription will be forwarded to the specialty pharmacy you selected on the Enrollment Form or to the specialty pharmacy required by the insurance plan.

Patient Benefit Investigation Only

Scenario: If you want the CSCN to conduct a patient benefit investigation, but do NOT want the CSCN to forward the prescription to the specialty pharmacy.

Prescription Order Only

Scenario: If you do NOT want the CSCN to conduct a patient benefit investigation and only want the CSCN to forward the prescription to the specialty pharmacy.

Please note: Delays may take place if an out-of-network specialty pharmacy is selected on the Enrollment Form.


2 WAYS TO ENROLL

Fill out and submit using an online portal

Download, print, complete, and fax the form

Contact the CSCN:     844-NEX-4321 (844-639-4321) OR 844-232-2618

This site is intended only for residents of the United States.

© 2021 Organon group of companies. All rights reserved. ORGANON and the ORGANON Logo are trademarks of the Organon group of companies. US-XPL-115396 09/21

© 2021 Organon group of companies. All rights reserved. ORGANON and the ORGANON Logo are trademarks of the Organon group of companies. US-XPL-115396 09/21