Bebtelovimab Requests

Bebtelovimab Requests

ATTENTION: Deadline for placing requests for this week's allocation is WEDNESDAY at 11:59PM. If your request is received after this deadline, it will be considered for the following week's allocation.

Due to supply chain challenges, delivery of OHA procured Bebtelovimab may be delayed.

How to report inventory and utilization:

To report utilization, please login to HPoP.

For assistance with basic HPoP processes please see our Provider Operations Manual (sections 3-5). The manual is also a good source of information on the ordering process, cadence, allocation and methodology.

Please visit our COVID-19 Therapeutics Landing Page for information and resources on mAbs and antivirals.

For all questions or inquiries, please email us at OHA.Therapeutics@odhsoha.oregon.gov.

We thank you for your understanding.

Attestation

Bebtelovimab supplied by OHA is intended for the uninsured & underinsured population. Per federal guidelines, commercially purchased Bebtelovimab is instructed to be used for patients with Medicaid, Medicare, health insurance, or those who can afford treatment without insurance.

Providers can purchase Bebtelovimab through their AmerisourceBergen accounts. Providers without an AmerisourceBergen account can contact service@asdhealthcare.com.

Attestation for Appropriate Usage*

I agree to use the Bebtelovimab requested via this survey and supplied by Oregon, for uninsured and underinsured patients to the best of my knowledge.

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Facility Information

Receiving Facility Name*

If you do not see your facility listed you may type it below.

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Street Address*

Please include suite, unit, and building numbers as appropriate.

City*

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Zipcode*

Product Order

Please request at a minimum the number of courses you expect to be able to use within 14 days. Please plan for each order to cover 2 weeks.

Quantity Requested*

Vials of Bebtelovimab requested for delivery. Bebtelovimab ships with 5 vials / package - please try to keep your order in increments of 5 vials. Deliveries for < 5 vials can be considered for special circumstances in low-volume practices.

Contact information

Point of contact for any follow up regarding this order.

Contact name*

Phone*

Phone

Email*

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