For Inpatient Use
How to Order Vistogard®
For Outpatient Use
To order Vistogard®
To Enroll Your Patient:
- Call Onco360® 1-844-374-0604
- Submit the Vistogard Rx Order Form by faxing to: 1-844-374-0605
- Submit via ePrescribe OncoMed dba Onco360 or NPI# 1679618151
- Onco360® will assess patient eligibility for Vistogard Co-Pay Assistance and Patient Assistance Program
Vistogard Rx Order Form
How Vistogard® (uridine triacetate) oral
granules is Supplied
| Name |
NDC |
Packets Per Carton |
Strength |
Form |
SPD Item No. |
| Vistogard® Full Course of Therapy |
50633-220-20 |
20 single-dose packets/carton |
Each packet contains 10g of oral granules |
Oral granules |
5420443 |
| Vistogard® 24-Hour Pack |
50633-220-04 |
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 to reach a reimbursement support
specialist or email us at serbreimbursement@serb.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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ofpatients following fluorouracil or capecitabine overdose or exhibiting
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onset, Severe Toxicides Associated With 5-Fluorouracil and
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symptomatic cardiotoxicity: A retrospective study o f452 consecutive
patients with metastatic breast cancer. BMJ Open, 6, e012798
- ISMP (2007) Fluorouracil Incident Root Cause Analysis
Fluorouracil Error Ends Tragically, But Application of Lessons Learned Will Save
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solution) Package Insert
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dihydropyrimidine dehydrogenase gene for the prediction of early-onset
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- Enroll patients as soon as Vistogard® is initiated by calling Onco360®
at 1-844-374-0604.
- The Vistogard® Case Management Program is administered by Onco360®
on behalf of SERB 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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