3-Step Metozolv™ ODT Reimbursement Information

This free support service helps patients with diabetic gastroparesis or refractory GERD get answers to third party payer coverage questions for Metozolv ODT. Our staff can also negotiate appeals on behalf of your patients should their claims be denied. The Helpline can also provide a timely solution to issues you may encounter either before or after submitting a patient claim for reimbursement, such as:

Receive current reimbursement policies for private payers, Medicaid, and Medicare
Verify individual patient coverage
Conduct prior authorizations
Manage negotiation of appeals on denied claims
Receive customized information to assist with coverage or appeals

Step 1. Fill out the Form

Download the Patient Information Form and fill it out

Download the Metozolv ODT Helpline Form (MS-Word)

For easy-to-follow instructions and an example of a filled-out Patient Information Form, click below to view our brochure, "Completing the Patient Information Form."

Download the Metozolv ODT Informational Brochure (PDF 472KB)

Step 2. Get Questions Answered

For questions regarding the Patient Information Form and reimbursement support, call the Helpline.

Metozolv ODT Reimbursement Helpline
1-877-305-4ODT (638)

Trained reimbursement analysts can answer your questions
Open Monday through Friday, 8:30 AM to 5:30 PM Eastern Standard Time

Step 3. Submit the Completed Form

Completed Patient Information Forms must be submitted via this fax number

Metozolv ODT Reimbursement Fax Line
1-800-387-5807

Reference: 1. METOZOLV ODT [package insert]. Morrisville, NC: Salix Pharmaceuticals, Inc; 2009.

IMPORTANT SAFETY INFORMATION

Treatment with metoclopramide can cause tardive dyskinesia, a serious movement disorder that is often irreversible. The risk of developing tardive dyskinesia increases with the duration of treatment and the total cumulative dose.
Metoclopramide therapy should be discontinued in patients who develop signs or symptoms of tardive dyskinesia. There is no known treatment for tardive dyskinesia. In some patients, symptoms may lessen or resolve after metoclopramide treatment is stopped.
Treatment with metoclopramide for longer than 12 weeks should be avoided in all but rare cases where therapeutic benefit is thought to outweigh the risk of developing tardive dyskinesia.

METOZOLV™ ODT (metoclopramide HCl) is indicated as short-term therapy for adults with symptomatic, documented gastroesophageal reflux disease (GERD) who fail to respond to conventional therapy and for the relief of symptoms associated with acute and recurrent diabetic gastroparesis (diabetic gastric stasis) in adults. Therapy should not exceed 12 weeks in duration. METOZOLV ODT is contraindicated in patients with intestinal obstruction, hemorrhage, or perforation; pheochromocytoma; known sensitivity or intolerance to metoclopramide; epilepsy; or are receiving concomitant medications with extrapyramidal reactions. METOZOLV ODT should be used with caution in patients showing acute dystonic reactions, drug-induced Parkinsonism, or other extrapyramidal symptoms; neuroleptic malignant syndrome; with a prior history of depression; hypertension; congestive heart failure and ventricular arrhythmia. Patients may experience withdrawal symptoms after stopping the use of METOZOLV ODT.

In clinical studies, the most frequently reported adverse events (≥2% occurrence) were headache, nausea, fatigue, somnolence, and vomiting.

Please see accompanying full Prescribing Information for Metozolv ODT, including BOXED WARNING.