Lybalvi Co-pay Savings Program

Funded

About

The Lybalvi Co-pay Savings Program offers significant financial assistance to patients using the drug Lybalvi. This program allows eligible patients to pay $0 for their first 3 fills and as little as $20 for subsequent refills, providing substantial savings on their Lybalvi prescriptions. With a 5-year renewable Co-pay Savings Card, the Lybalvi Co-pay Savings Program ensures long-term affordability for patients meeting all criteria.

Insurance requirements: Commercially insured

Enrollment Forms

Enrollment Form

Program Requirements

•Must be 18 years of age or older

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: No

•Activation Required: No

Program Details

•Patient pays $0 for their first 3 fills and as little as $20 for every refill after their first 3 fills

•Maximum savings limit applies; patients’ outofpocket expenses may vary; maximum 30day supply per fill for the first 3 fills; beginning at fill 4, a maximum savings of $450 per 30day supply will be provided towards the cost of the LYBALVI prescription

•For questions regarding setup, claim transmission, patient eligibility, or other issues, call the LoyaltyScript® Program for the LYBALVI Copay Savings Program at 18558209624 (8:00 AM8:00 PM EST, MondayFriday)

•The Lybalvi Copay Savings Card expires 5 years after original use, but may be renewed if all eligibility criteria are met

•The LYBALVI Copay Savings Card expires after 5 years but may be renewed if all eligibility criteria are met.

Enrollment Forms

Enrollment Form

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Pay as low as

$0/ fill

Other Tools for Lybalvi

Check medication interactions

Get prior authorization forms

Get patient education materials