GELCLAIR Patient Rx Program from Fortovia Direct Rx

Prescribe with confidence with the Fortovia Direct Rx Access Program

  • Affordable access for your patients
    • All eligible patients pay $25 out-of-pocket costs for 1 month of therapy*
    • Patients can receive free door-to-door service when health care professionals order directly from a Fortovia Direct Rx specialty pharmacy
  • Streamlined Patient Assistance Program for most noneligible patients

The Fortovia Direct Rx Access Program: Easy for you, affordable for your patients

  • Prescribe via faxed form or e-prescribe via Electronic Health Record (EHR) directly from a Fortovia Direct Rx specialty pharmacy
  • All eligible patients pay $25 out-of-pocket costs*
  • A streamlined Patient Assistance Program is available for uninsured, underinsured, Medicare, Medicaid, and indigent patients
  • Free, 24-48 hour home delivery of product when ordered from a specialty pharmacy within the Fortovia Direct Rx network

Important

Remind patients that the specialty pharmacy must contact them via phone prior to shipping their prescription to verify insurance, address and collect co-pay.

*Terms and Conditions: Certain patients in Federal programs may not qualify. Qualified patients will pay $25 per GELCLAIR prescription. After a maximum reimbursement allowance, any remaining costs will be the responsibility of the patient. Co-pay assistance is not valid for prescriptions reimbursed, in whole or in part, under Medicaid, Medicare, including Medicare Advantage and Part D prescription drug plans, or any other federal or state program (including state pharmaceutical assistance programs) or where prohibited, taxed, or otherwise restricted. Fortovia Therapeutics Inc. reserves the right to rescind, revoke, or amend this offer without notice. Patients understand and agree to comply with the terms and conditions of this offer as set forth here.

How to prescribe GELCLAIR Oral Gel

GELCLAIR is available to patients via the GELCLAIR Rx Program, Fortovia Direct Rx, or through their local retail pharmacy

The recommended dose of GELCLAIR is one packet 3 times daily (TID), or as needed. Each single-use packet contains 15 mL of GELCLAIR bioadherent oral gel.

GELCLAIR is available in a 90-count box containing a full month’s prescription. It is also available in a 15-count box.

For additional information on dosing and administration, please see the full GELCLAIR Prescribing Information.

Reference

  1. Innocenti M, Moscatelli G, Lopez S. Efficacy of Gelclair in reducing pain in palliative care patients with oral lesions: preliminary findings from an open pilot study [letter]. J Pain Symptom Manage. 2002;24(5):456-457.

INDICATIONS

GELCLAIR has a mechanical action indicated for the management of pain and relief of pain by adhering to the mucosal surface of the mouth, soothing oral lesions of various etiologies, including oral mucositis/stomatitis (may be caused by chemotherapy or radiation therapy), irritation due to oral surgery, traumatic ulcers caused by braces or ill-fitting dentures, or disease. Also, indicated for diffuse aphthous ulcers.

IMPORTANT SAFETY INFORMATION

  • Do not use GELCLAIR if there is a known or suspected hypersensitivity to any of its ingredients.
  • No adverse effects have been reported in clinical trials, although postmarketing reports have included infrequent complaints of burning sensation in the mouth.
  • If GELCLAIR is swallowed accidentally, no adverse effects are anticipated.
  • If no improvement is seen within 7 days, a physician should be consulted.

You are encouraged to report negative side effects of prescription medical products to the FDA.
Visit www.fda.gov/safety/medwatch, or call Fortovia at 1-855-273-0468 for medical inquiries.

Please see full Prescribing Information.

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INDICATIONS

GELCLAIR has a mechanical action indicated for the management of pain and relief of pain by adhering to the mucosal surface of the mouth, soothing oral lesions of various etiologies, including oral mucositis/stomatitis (may be caused by chemotherapy or radiation therapy), irritation due to oral surgery, traumatic ulcers caused by braces or ill-fitting dentures, or disease. Also, indicated for diffuse aphthous ulcers.

IMPORTANT SAFETY INFORMATION

  • Do not use GELCLAIR if there is a known or suspected hypersensitivity to any of its ingredients.
  • No adverse effects have been reported in clinical trials, although postmarketing reports have included infrequent complaints of burning sensation in the mouth.
  • If GELCLAIR is swallowed accidentally, no adverse effects are anticipated.
  • If no improvement is seen within 7 days, a physician should be consulted.

You are encouraged to report negative side effects of prescription medical products to the FDA.
Visit www.fda.gov/safety/medwatch, or call Fortovia at 1-855-273-0468 for medical inquiries.

Please see full Prescribing Information.