Lina has CDD. She was not taking
ZTALMY at the time of this photo.

RESOURCES AND
SUPPORT FOR YOU AND YOUR PATIENTS

Lina has CDD. She was not taking
ZTALMY at the time of this photo.

Resources for your patient's treatment journey

Download

Fax Cover Sheet: Download a cover sheet for faxing ZTALMY One enrollment materials

Appeal Letter Template: Download a sample letter for appealing prior authorization decisions

Prescribing ZTALMY

ZTALMY is supplied through Orsini Specialty Pharmacy by ZTALMY One, a comprehensive support program for you and your patients. Follow these steps to prescribe ZTALMY and enroll your patients in ZTALMY One.

Fill out the ZTALMY One Enrollment Form.

Have your patient's caregiver sign the enrollment form to receive additional resources from ZTALMY One throughout treatment. Your patient's caregiver can sign the form electronically.

Include a Letter of Medical Necessity (LMN) and any clinical notes, including documentation of the patient’s diagnosis if available, with the enrollment form to support the prior authorization process. The Clinical Documentation Reference can help you capture relevant clinical information for the LMN.

Fax the ZTALMY One Enrollment Form and supporting documentation to 1‑844‑ZTALMY‑F (1‑844‑982‑5693). Download the ZTALMY One Fax Cover Sheet.

What's next? After you submit the enrollment form and supporting documentation, ZTALMY One will contact your office confirming that we have everything we need to begin prior authorization.

ZTALMY One provides resources, support, and education to help your patients throughout treatment.

ZTALMY One helps facilitate access to treatment

After you prescribe ZTALMY, ZTALMY One will provide support throughout the entire access process

Benefits verification

ZTALMY One will investigate your patient’s benefits, including specific coverage and payer requirements. If there are any issues, such as patient eligibility, a Patient Care Coordinator* will reach out to you within 2 business days to explain what is needed.

Prior authorization support

ZTALMY One provides prior authorization and appeals support. To help with prior authorization, a Patient Care Coordinator will:

Create a patient key in CoverMyMeds® for each patient and upload all relevant documentation.

Contact you to fill in any outstanding information for the CoverMyMeds® patient key.

Be sure to sign and submit the prior authorization in CoverMyMeds® so that it can be processed.

If a prior authorization does not get approved, ZTALMY One will investigate the reasons for denial or rejection, and provide support for an appeal, including an appeals template if needed.

Download the Appeal Letter Template.

Your patient's prescription delivery

Once your patient's coverage has been determined, ZTALMY One will contact the caregiver to coordinate delivery and discuss any out-of-pocket costs. Please remind caregivers that they must answer or return this call to receive their prescription.

*ZTALMY One Patient Care Coordinators do not provide medical advice or individual patient care.

ZTALMY One helps make treatment more affordable

The ZTALMY One Copay Savings Program helps commercially insured eligible patients pay as low as zero dollars per fill for a ZTALMY prescription*

*Eligible patients may pay as low as $0 per fill for a ZTALMY prescription for a maximum 30-day supply per fill and assistance may be up to a maximum of $25,000 per calendar year. State and federal health care program beneficiaries not eligible even if they elect to be processed as an uninsured (cash-paying) patient. The savings program is not health insurance. Marinus reserves the right to rescind, revoke or amend this offer without notice. Click here for full terms and conditions. For questions, please call ZTALMY One (1‑844‑982‑5691).

If your patient has no insurance, limited insurance, or a gap or delay in coverage, Prescription Support Programs may be able to help with the cost of your patient's prescription.

*Eligible patients may pay as low as $0 per fill for a ZTALMY prescription for a maximum 30-day supply per fill, subject to an annual maximum. State and federal health care program beneficiaries not eligible even if they elect to be processed as an uninsured (cash-paying) patient. The savings program is not health insurance. Marinus reserves the right to rescind, revoke or amend this offer without notice. Click here for full terms and conditions. For questions, please call ZTALMY One (1‑844‑982‑5691).

ZTALMY One provides ongoing support for your patients

Caregivers will receive monthly check-in calls from ZTALMY One to discuss:

Any weight changes that may affect their child's dosage
Upcoming refills
The next delivery of ZTALMY to the patient's home

DOSING

SAFETY

Program Eligibility and Terms and Conditions

The copay savings program requires a valid prescription for ZTALMY® (ganaxolone) oral suspension, CV consistent with the Prescribing Information.

Patient must have commercial insurance. Offer is not valid for cash-paying patients.

Patient must reside in the U.S. or U.S. Territory.

Patients are responsible for as low as a zero-dollar copayment for a ZTALMY prescription for a maximum 30-day supply per fill. The value of the copay savings program offer is limited to an annual maximum per calendar year. For maximum annual benefit limit information, please contact ZTALMY One™ (1‑844‑982‑5691).

Patients are not eligible to use this offer if they are eligible for or enrolled in a state or federally funded insurance program, including but not limited to Medicare, Medicaid, TRICARE, Veteran Affairs health care or a state prescription drug assistance program.

You are responsible for reporting use of the copay savings program to any commercial insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the copay savings program, as may be required. You should not use the copay savings program if your insurer or health plan prohibits use of manufacturer copay programs.

Offer not valid where prohibited by law.

Copay Savings Program accepted only by the ZTALMY One designated specialty pharmacy.

If patient’s insurance changes, the pharmacy must be notified immediately. Based on patient’s insurance change, patient may no longer be able to participate in the copay savings program.

Offer is not health insurance.

Offer good only in the U.S.

Offer is limited to one per person during this offering period and is not transferable.

Offer is not conditioned on any past, present, or future purchase, including refills.

Marinus reserves the right to rescind, revoke or amend this offer and program eligibility requirements at any time without notice.

RESOURCES AND
SUPPORT FOR YOU AND YOUR PATIENTS

Resources for your patient's treatment journey

ZTALMY One^TM Enrollment Form: A form for prescribing ZTALMY and enrolling patients in ZTALMY One

Sample Letter of Medical Necessity (LMN): A template letter that can be customized by your office

Clinical Documentation Reference: This reference can help you provide relevant clinical information in the LMN

Getting Your Patients Started on ZTALMY: Instructions for prescribing ZTALMY and information on how ZTALMY One works

Dosage & Titration Reference for ZTALMY: Information on dosing and titrating ZTALMY

How to Give ZTALMY: Detailed and illustrated instructions for how to prepare and administer ZTALMY

Treatment Tracker: A convenient tracker for caregivers to record their child’s dosing and titration

Caregiver Brochure: Helpful information for caregivers that may be considering ZTALMY for their child

Getting Started Brochure: Resource to help caregivers learn more about starting ZTALMY and the support services available to them