How to Enroll
Access every document you and your CPP patients need to enroll in Fensolvi treatments.
Use the following forms to help your patients enroll in Fensolvi treatment.
Every patient must start with the Patient Enrollment Form, while all other forms can be filled out on an as-needed basis.
Once these forms are completed, Fensolvi treatments will be delivered.
Patient Enrollment Form.
3 Steps to Fensolvi Easy Access
To use Fensolvi TotalSolutions Hub powered by Scripts Rx, follow these three steps.
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Remove old Patient Enrollment forms from the system and/or save Scripts Rx to your favorites in your preferred EMR.
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Fax your Fensolvi patient enrollment form OR use your current eRx platform to send a prescription order directly to Fensolvi TotalSolutions via the Scripts Rx Pharmacy.
Fax: 877-991-1798
NPI: 1144730995 | NABP Number: 5922592![Group 16831]()
Tell families and caregivers to expect a call/text from Scripts Rx Pharmacy to authorize their child’s Fensolvi prescription.
Our Patient Access Promise
Easy access to Fensolvi for those who need it most
Access to Fensolvi has never been easier. We guarantee all commercially insured patients can access our treatment for as little as $5.
Along with insurance coverage, we also deliver a full line of support services for medical practices, patients, and caregivers through Fensolvi TotalSolutions. Patient enrollment, case management, benefits eligibility inquiry, and more are all taken care of so your patients can just focus on being a kid.
IMPORTANT SAFETY INFORMATION
FENSOLVI (leuprolide acetate) for injectable suspension is a gonadotropin releasing hormone (GnRH) agonist used to treat patients 2 years of age and older with central precocious puberty (CPP). CPP may be diagnosed when signs of sexual maturity begin to develop in girls under the age of 8 or in boys under the age of 9.
FENSOLVI is contraindicated in individuals with hypersensitivity to any drug that is in the same class as FENSOLVI, in individuals who are allergic to any of the ingredients in FENSOLVI, or in individuals who are pregnant. FENSOLVI may cause fetal harm when administered to a pregnant patient.
During the first few weeks of treatment, increases in gonadotropins and sex steroids above baseline may result in an increase in signs and symptoms of puberty including vaginal bleeding in girls.
Psychiatric events have been reported in patients taking GnRH agonists. Events include emotional lability, such as crying, irritability, impatience, anger, and aggression. Patients should be monitored for development or worsening of psychiatric symptoms.
Convulsions have been observed in patients treated with GnRH agonists with or without a history of seizures, epilepsy, cerebrovascular disorders, central nervous system anomalies or tumors, and in patients on concomitant medications that have been associated with convulsions such as bupropion and SSRIs.
Pseudotumor Cerebri (Idiopathic Intracranial Hypertension) has been reported in pediatric patients treated with GnRH agonists. Patients should be monitored for headache, papilledema and blurred vision.
The most common adverse reactions seen with FENSOLVI were: injection site pain, nasopharyngitis, pyrexia, headache, cough, abdominal pain, injection site erythema, nausea, constipation, vomiting, upper respiratory tract infection, bronchospasm, productive cough and hot flush.
Please see Full Prescribing Information for FENSOLVI for additional important safety information.
To report suspected adverse reactions contact Tolmar at 1-844-4TOLMAR (486-5627) or the FDA at 1-800-FDA-1088 or visit www.fda.gov/medwatch.
IMPORTANT SAFETY INFORMATION
FENSOLVI (leuprolide acetate) for injectable suspension is a gonadotropin releasing hormone (GnRH) agonist used to treat patients 2 years of age and older with central precocious puberty (CPP). CPP may be diagnosed when signs of sexual maturity begin to develop in girls under the age of 8 or in boys under the age of 9.
FENSOLVI is contraindicated in individuals with hypersensitivity to any drug that is in the same class as FENSOLVI, in individuals who are allergic to any of the ingredients in FENSOLVI, or in individuals who are pregnant. FENSOLVI may cause fetal harm when administered to a pregnant patient.
During the first few weeks of treatment, increases in gonadotropins and sex steroids above baseline may result in an increase in signs and symptoms of puberty including vaginal bleeding in girls.
Psychiatric events have been reported in patients taking GnRH agonists. Events include emotional lability, such as crying, irritability, impatience, anger, and aggression. Patients should be monitored for development or worsening of psychiatric symptoms.
Convulsions have been observed in patients treated with GnRH agonists with or without a history of seizures, epilepsy, cerebrovascular disorders, central nervous system anomalies or tumors, and in patients on concomitant medications that have been associated with convulsions such as bupropion and SSRIs.
Pseudotumor Cerebri (Idiopathic Intracranial Hypertension) has been reported in pediatric patients treated with GnRH agonists. Patients should be monitored for headache, papilledema and blurred vision.
The most common adverse reactions seen with FENSOLVI were: injection site pain, nasopharyngitis, pyrexia, headache, cough, abdominal pain, injection site erythema, nausea, constipation, vomiting, upper respiratory tract infection, bronchospasm, productive cough and hot flush.
Please see Full Prescribing Information for FENSOLVI for additional important safety information.
To report suspected adverse reactions contact Tolmar at 1-844-4TOLMAR (486-5627) or the FDA at 1-800-FDA-1088 or visit www.fda.gov/medwatch.
References
- Fensolvi® (leuprolide acetate) for injectable suspension 45 mg Prescribing Information. Dublin 2, Ireland: Tolmar International, Ltd.; 11/2022.
- Klein K, Freire A, Gryngarten M, et al. Phase 3 trial of a small-volume subcutaneous 6-month duration leuprolide acetate treatment for central precocious puberty. J Clin Endo Metab. 2020;105(10):1-12.
- Prettyman J, Engel L, Boldt-Houle D, et al. Personalizing treatment in the delivery of care by nurses to patients with prostate cancer. Urologic Nursing. 2019;39(2):83-99
- LUPRON DEPOT-PED [package insert]. North Chicago, IL: AbbVie Inc.
- Triptodur [package insert]. Atlanta, GA: Arbor Pharmaceuticals, LLC.
- Russo LG, Moore WV. 444 Comparison of intramuscular and subcutaneous injections of growth hormone. Pediatric Research 1981 15(4) 514
- Leung AK, Chiu AS, Siu TO. Subcutaneous versus intramuscular administration of Haemophilus influenzae type b vaccine. J R Soc Health. 1989;109(2):71-73.
- Sartor O. A new form of treatment for prostate cancer. European Urology Supplements. 2006;5:905-910.
FENSOLVI TOTALSOLUTIONS COPAY PROGRAM TERMS AND CONDITIONS
The Fensolvi® Co-pay Assistance Program (“Program”) is valid ONLY for patients who are prescribed Fensolvi® and are reimbursed exclusively by commercial insurance. This Program is valid only in the United States; but, void where prohibited by law or by the patient’s health insurance provider. This Program is non-transferable, limited to one per person, and cannot be combined with any other coupon, free trial, discount, prescription savings card, or other offer. Restrictions or limits may apply.
Medicare, Medicaid, Tricare and other federal health care program beneficiaries may not participate in this Program. This Program also is neither available for cash paying patients nor where your commercial plan reimburses you for the entire cost of your prescription drug. Patients cannot seek reimbursement from health insurance or any third party for any part of the assistance received through this Program. The patient or his/her guardian is responsible for reporting the receipt of all benefits or reimbursement received under the Program to any insurer, health plan, or other third party, as may be required. This Program is not insurance and is not intended as a substitute for insurance.
With the Program, you pay as little as $5 of your co-pay or co-insurance for Fensolvi®, per prescription. The remainder of your co-pay or co-insurance is covered, up to two prescriptions per calendar year. The Program assists with the cost of Fensolvi only. It does not assist with the cost of other administrations, medicines, procedures or office visit fees.
Tolmar, Inc. (“Tolmar”) reserves the right to terminate, rescind, revoke, or modify this Program at any time without notice. This Program expires at the end of the current calendar year, at which time you must re-enroll. For complete information about the terms and conditions of this Program, including the limitations on use and the amount of assistance call 1 866-FENSOLVI (336-7658).
Program managed by Scripts Rx on behalf of Tolmar.
