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