Vivitrol Co-pay Savings Program
Funded
About
The Vivitrol Co-pay Savings Program offers substantial savings for patients prescribed Vivitrol, allowing eligible participants to potentially pay as little as $0 per prescription. This program specifically supports the out-of-pocket costs for the drug Vivitrol, providing financial assistance that can cover up to $500 per month, making treatments more accessible. The Vivitrol Co-pay Savings Program is dedicated to easing the financial burden for patients by offering consistent savings throughout the year, with eligibility for renewal every five years.
Insurance requirements: Commercially insured, Underinsured, Uninsured
Enrollment Forms
Enrollment Form
Benefits
•$6000 annual maximum benefit
•12 maximum fills per year
Program Requirements
•Valid only for residents in the US and Puerto Rico
•Must be 18 years of age or older
•Enrollment Required: Yes
•Coverage Required: No
•Needs Based: No
•Activation Required: Yes
Program Details
•Eligible patients may pay as little as $0 per prescription, up to $500 per month, and only for prescriptions for FDAapproved indications; once maximum benefit is reached, patient is responsible for all remaining outofpocket costs
•Card can be used for as long as the patient is prescribed Vivitrol, up to 12 times per calendar year
•The VIVITROL Copay Savings Card expires after 5 years but may be renewed if all eligibility criteria are met
•Eligible patients may receive benefits for valid claims submitted with a date of service that is up to 90 days prior to the initial enrollment date
•Program assists with the outofpocket cost for VIVITROL only; it does not assist with any other outofpocket costs (e.g., for the office visit or medication administration) even if such costs are associated with VIVITROL administration
•For questions regarding setup, claim transmission, patient eligibility, or other issues, call the program support line for the VIVITROL Copay Savings Program at 18778383836 (8:00 AM8:00 PM ET, MondayFriday).
Enrollment Forms
Enrollment Form