VIMPAT PATIENT SAVINGS PROGRAM
Eligible commercial patients paid as little as $20 per 30-day supply of VIMPAT with the VIMPAT Patient Savings Program*
Ask your sales representative for details about the program.
Patients are responsible for a minimum of $20 out-of-pocket expense per 30-day supply. This card will then be applied toward any remaining out-of-pocket expense up to a maximum of $1300. If you have any questions regarding your eligibility or benefits or if you wish to discontinue your participation, call the VIMPAT Savings Program at 1-888-786-5879 (8:30 AM - 5:30 PM EST, Monday-Friday and 8:30 AM - 2:30 PM EST, Saturday). This savings card is not valid for use by patients who are covered by any federally funded or state-funded healthcare program (including, but not limited to, Medicare [Part D and Medigap], Medicaid, any state pharmaceutical assistance program, TRICARE, VA, or DoD). Offer good only in the U.S., including Puerto Rico. This card may only be used with a valid VIMPAT prescription at the time the prescription is filled by the pharmacist and dispensed to the patient. The maximum annual benefit amount is $1300 per calendar year. Void where prohibited by law, taxed, or restricted. This offer cannot be combined with any other promotional offer. UCB, Inc. reserves the right to rescind, revoke, or amend this offer without notice at any time. No cash value. Not eligible for sale, purchase, trade, or counterfeit.
initiating prior authorization and/or tier medical exception requests (if required) for your completion.
- Patient must have a valid prescription consistent with the FDA-approved product labeling for VIMPAT® (lacosamide) CV to participate in the VIMPAT Direct Purchase Program.
- The VIMPAT Direct Purchase Program is available to residents of the United States and all United States Territories only.
- Program is not available where prohibited by law.
- The VIMPAT Direct Purchase Program operates outside of any third-party insurance. Neither the patient nor the pharmacy nor anyone else acting on the patient’s behalf may submit any claim for reimbursement for product dispensed pursuant to this program to any third-party payer, including Medicare, Medicaid, or any other federal or state healthcare program. Out-of-pocket expenses incurred when using this program cannot be applied toward any government insurance benefit out-of-pocket spending calculations, such as Medicare Part D True Out-of-Pocket Costs (TrOOP).
- The VIMPAT Direct Purchase Program does not include all Manufacturer products. Eligible patients may purchase the following Manufacturer products from the program: VIMPAT.
- The VIMPAT Direct Purchase Program is not health insurance nor is participation a guarantee of insurance coverage.
- Limitations may apply.
- The VIMPAT Direct Purchase Program cannot be combined with any other savings, free trial, or similar offer for the specified prescription.
- Manufacturer reserves the right to rescind, revoke, or amend this program without notice.