Vyepti Connect Copay Assistance Program
Not Funded
About
The Vyepti Connect Copay Assistance Program offers significant financial support to eligible patients using the drug Vyepti. Through the program, patients may pay as little as $0 per infusion, with a maximum assistance cap of $200 per infusion for administration costs. The Vyepti Connect program ensures that the cost of the Vyepti product is minimized, providing a calendar year maximum for all out-of-pocket expenses. The program is designed to effectively support patients in managing their prescription costs for Vyepti, making treatments more accessible and affordable.
Insurance requirements: Commercially insured
Enrollment Forms
Enrollment Form
Benefits
•$2400 annual maximum benefit
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 infusion
•Program assistance cap of $200 per infusion for eligible administration costs; calendar year maximum on all program assistance for all outofpocket expenses
•Copay assistance applies to the cost of the product only; any administration costs (e.g., cost of IV infusion) or other fees are the responsibility of the patient.
•Must have a valid prescription for VYEPTI (up to 300 mg) for an approved indication at the time the prescription is filled by the pharmacist, or at the time the HCP administers VYEPTI to the patient
•HCP or office personnel will need to fax or email documentation, typically in the form of an Explanation of Benefits (EOB) after each dose.
•• The tollfree fax number is 8662183479; reimbursement will be sent after the EOB is reviewed and approved
•All documentation can also be mailed to: Attn: VYEPTI CONNECT Copay Assistance Program, 2250 Perimeter Park, Suite 300, Morrisville, NC 27560
•Patient enrollment will automatically renew each calendar year
•Call 8334893784, Monday through Friday, 8 AM 8 PM ET, for assistance or additional information
•Patients residing in MA, MN, and RI are not eligible for copay assistance for product administration costs
Enrollment Forms
Enrollment Form