For Inpatient Use
How to Order Vistogard®
IMPORTANT: Enroll patients in the Vistogard® Case Management
Program immediately after initiation of therapy to avoid potential treatment disruptions if the
patient is subsequently transferred to a non-inpatient setting. The Case Management Program is
administered by BioMatrix Specialty Pharmacy, the Specialty Pharmacy for Vistogard®.
Click the Case Management button below for additional details on the program from BioMatrix
Specialty Pharmacy.
Case Management
Prescription Form
For Outpatient Use
To order Vistogard®
- To order Vistogard® call 1-855-855-0708.
- Vistogard® is supplied exclusively through:
- Specialty Distributor (for institutions with dispensing capabilities): Cardinal Health SPD*,
available 24 hours/day, 7 days/week
- Specialty Pharmacy: BioMatrix Specialty Pharmacy, Phone: 1-844-374-0604.,
Fax number: 1-844-374-0605.
IMPORTANT: Enrollment of patients in the Case Management Program can
provide access to adherence support and/or assistance programs. Click the Case Management button
below for additional details on the program from BioMatrix Specialty Pharmacy.
Case Management
Prescription Form
How Vistogard® (uridine triacetate) oral
granules is Supplied
| Name |
NDC |
Packets Per Carton |
Strength |
Form |
SPD Item No. |
| Vistogard® Full Course of Therapy |
69468-151-20 |
20 single-dose packets/carton |
Each packet contains 10g of oral granules |
Oral granules |
5420443 |
| Vistogard® 24-Hour Pack |
69468-151-04 |
4 single-dose packets/carton |
Each packet contains 10g of oral granules |
Oral granules |
5420450 |
Vistogard Reimbursement
Please call us at 1-844-293-0007, Option 6 to
reach a reimbursement support specialist or email us at BTG@thepinnaclehealthgroup.com and your
inquiry will be routed to our reimbursement support team to assist you with your needs and any other
questions you may have.
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- Enroll patients as soon as Vistogard® is initiated by calling BioMatrix Specialty
Pharmacy at 1-844-374-0604.
- The Vistogard® Case Management Program is administered by BioMatrix Specialty
Pharmacy on behalf of BTG Pharmaceuticals
- Benefits of the Case Management Program include:
- Facilitate a smooth pathway to transition patients from inpatient to outpatient care
- Delivery to the appropriate setting or to the patient’s home
- Provide instructions on dosing and administration
- Adherence calls once per day to ensure completion of the full 20-dose course of therapy (1
dose, every 6 hours, for 5 days)
- Assessment of eligibility for the Vistogard® Support Programs
- Patient Assistance Program & Co-Pay Assistance
- Prescription Form can be downloaded here.
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