Nuzyra Central

WELCOME TO NUZYRA® CENTRAL

When you complete the prescription form below, information will be sent to NUZYRA Central, which will evaluate coverage and affordability options for your patient.

  • Benefits Verification (BV)
  • Prior Authorization Support
  • Copay assistance
  • Triage to network specialty pharmacy
  • Evaluate for Patient Assistance Program

Please complete the fields below to prescribe NUZYRA for your patient.

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REQUESTOR INFORMATION

*Requestor:

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Ship To:

HEALTHCARE PROVIDER / FACILITY INFORMATION

PATIENT INFORMATION

Gender

PATIENT INSURANCE INFORMATION


CLINICAL INFORMATION

Primary Diagnosis/ICD-10-CM:

Click to add or subtract
additional codes

PRESCRIPTION / ORDER INFORMATION

Product: NUZYRA 150 mg Tablets

CABP

Route of Administration: PO

300 mg twice on day 1

300 mg once daily x days

Total # of tablets: {{ this.cabpTotal }}

ABSSSI

Route of Administration: PO

450 mg once daily x 2 days

300 mg once daily x days

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Route of Administration: PO

300 mg once daily x days

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Drug Allergies

Prescriber Signature Required for Prescription Orders

I certify that the information provided in this Patient Support Enrollment Form is complete and accurate to the best of my knowledge. By signing this Patient Support Enrollment Form, I certify that I have prescribed NUZYRA based on my professional judgment of medical necessity and that I will supervise the patient's medical treatment. I authorize Paratek Pharmaceuticals, Inc. (“Paratek”), Occam Health Services, LLC (“Occam”), and/or any pharmacy in the limited distribution network of pharmacies that are authorized by Paratek to dispense NUZYRA (“Network Pharmacy”) to provide any information on this form or any other medical information provided by me to Paratek, Occam and/or Network Pharmacy to the insurer of the named patient and to forward the above prescription, by fax or by other mode of delivery, to the pharmacy chosen by the named patient.

Special Note: In addition to completing this section, NY Prescribers may be asked to e-prescribe to an appropriate pharmacy per NY State law

WELCOME TO NUZYRA® CENTRAL


We have received your NUZYRA® (omadacycline) request. If the patient or HCP was not present at the time you submitted the request, they will receive a link (via email) to sign the consent and authorization. NUZYRA Central® understands the needs of your patient and based on their coverage, we will look for the most appropriate patient services available.


Questions? Call NUZYRA® Central Support Services at 1-877-4-NUZYRA (1-877-468-9972),
Mon-Fri, 8 AM to 8 PM ET to speak with a representative.

ICD-10 Lookup

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SPECIALTY PHARMACY PARTNER FINDER

Please use the finder below to select a pharmacy that carries NUZYRA® (omadacycline) tablets.

* This information is current as of 07/25/2024.
NUZYRA is available at pharmacies in the NUZYRA Pharmacy Network. Paratek Pharmaceuticals, Inc. does not recommend or prefer the use of one pharmacy over another.

Inventory may vary. Check with your local pharmacy for availability and additional guidance.

Pharmacies near you

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NUZYRA Pharmacy Network

All pharmacies are able to provide same day or next day delivery of NUZYRA.

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