•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).