SAVINGS

VIMPAT PATIENT SAVINGS PROGRAM

NEARLY 75% OF ELIGIBLE PATIENTS* PAID AS LITTLE AS $20 PER 30-DAY SUPPLY OF VIMPAT WITH THE VIMPAT PATIENT SAVINGS PROGRAM.1

Ask your sales representative for details about the program.

VIMPAT® (lacosamide) CV Patient Savings Card Image

 

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 $100. Most patients who have commercial prescription insurance are eligible. 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 federal 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 is good for use only 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.

Assistance

WHEN A PRIOR AUTHORIZATION IS REQUIRED, PARX SOLUTIONS®
AND COVERMYMEDS® CAN PROVIDE ASSISTANCE.

PARx SOLUTIONS AND COVERMYMEDS OFFER PRIOR AUTHORIZATION (PA) ASSISTANCE THROUGH AN ELECTRONIC-BASED SYSTEM THAT STANDARDIZES THE MEDICAL NECESSITY REQUEST PROCESS FOR MOST INSURANCE PROVIDERS, AND FOR PATIENTS WITH COMMERCIAL, MEDICARE PART D, AND MEDICAID COVERAGE.*

VIMPAT® (lacosamide) CV PARx Solutions Logo and % Prior Authorizations Approved

PARx Support Solutions for Prescribers (PASS)

  • PARx Solutions helps prescribers easily navigate the PA process by providing digital PAs via secure web-based and pharmacy-driven support

Get started in 4 simple steps:

  1. Physician completes and submits universal insurance PA request form
  2. PARx completes proper PA health plan form
  3. PARx submits form to proper health plan
  4. PARx works with office if additional information is needed and follows up on outcome of submission
  5. For more information, visit www.parxsolutions.com.

VIMPAT® (lacosamide) CV CoverMyMeds Logo and % Prior Authorizations Approved

Pharmacy-initiated PA requests

  • If a prescription is submitted to a participating pharmacy and requires a PA, CoverMyMeds facilitates the approval process by delivering a PA to your office for completion, signature and submission to the health plan
  • More than 90% of retail pharmacies participate in CoverMyMeds12

Physician-initiated PAs

  • CoverMyMeds also offers a web-based portal that can help your office by automating the PA process, saving prescribers and staff time and ensuring patients receive their medication faster

Get started online at www.covermymeds.com, by email at help@covermymeds.com, or by phone
at 1-866-452-5017.

Currently, Medi-Cal, Washington State Medicaid, and Wisconsin State Medicaid require the pharmacy to submit prior authorization forms and may not be applicable to this program. This list is subject to change based on plan requirements.

†Year-to-date average does not indicate or guarantee an individual’s approval for VIMPAT.

FINANCIAL ASSISTANCE MAY BE AVAILABLE FOR VIMPAT PATIENTS.

The VIMPAT Patient Assistance Program may be able to help if your patients do not have health insurance or if they are a Medicare Part D recipient and cannot afford VIMPAT. Eligible patients are provided a free 6-month supply of medicine and can reapply every six months for continuing support.

To learn more about the VIMPAT Patient Assistance Program or to find out if your patient might be eligible for assistance, please contact UCBCares at 1-844-599-CARE (2273), or AskUCBCares.com, or click below to get started.

 

Program Instructions and Application Form

VIMPAT® (lacosamide) CV Free Trial Voucher

FREE TRIAL

Receive a FREE 2-Week Trial of VIMPAT.

CONTACT YOUR REPRESENTATIVE TO RECEIVE A PATIENT VOUCHER FOR A 14-DAY SUPPLY OF VIMPAT.

Or call UCBCares at 1-844-599-CARE (2273) or email UCBCares@ucb.com.

References

  1. 1.Data on file. UCB, Inc.
  2. 10.PARx Solutions Inc., November 2016.
  3. 11.CoverMyMeds LLC, December 2017.
  4. 12.CoverMyMeds website: https://www.covermymeds.com/main/. Accessed October 9, 2017.

Important Safety Information

Warnings and Precautions

  • Suicidal Behavior and Ideation: Antiepileptic drugs (AEDs), including VIMPAT, increase the risk of suicidal behavior and ideation. Monitor patients taking VIMPAT for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior. Advise patients and caregivers to be alert for these behavioral changes and to immediately report them to the healthcare provider.

  • Dizziness and Ataxia: VIMPAT may cause dizziness and ataxia. In adult clinical trials, the onset of dizziness and ataxia was most commonly observed during titration. Advise patients not to drive, operate complex machinery, or engage in other hazardous activities until they are familiar with the effects of VIMPAT on their ability to perform such activities. Dizziness and ataxia were also observed in pediatric clinical trials.

  • Cardiac Rhythm and Conduction Abnormalities:

    PR interval prolongation

    Dose-dependent prolongations in PR interval with VIMPAT have been observed in clinical studies in adult patients and in healthy volunteers. Second-degree and complete AV block have been reported in patients with seizures. When VIMPAT is given with other drugs that prolong the PR interval, further PR prolongation is possible.

    Use VIMPAT with caution in patients with known cardiac conduction problems (e.g., marked first-degree AV block, second-degree or higher AV block and sick sinus syndrome without pacemaker), sodium channelopathies (e.g., Brugada Syndrome), or with severe cardiac disease such as myocardial ischemia or heart failure, or structural heart disease. Also, use VIMPAT with caution in patients on concomitant medications that prolong PR interval (e.g., beta-blockers and calcium channel blockers) because of a risk of AV block or bradycardia. In such patients, obtaining an ECG before beginning VIMPAT, and after VIMPAT is titrated to steady-state maintenance dose, is recommended. In addition, closely monitor these patients if they are administered VIMPAT through the intravenous route.

    Atrial fibrillation and Atrial flutter

    VIMPAT administration may predispose to atrial arrhythmias (atrial fibrillation or flutter), especially in patients with diabetic neuropathy and/or cardiovascular disease.

  • Syncope: VIMPAT may cause syncope in adult and pediatric patients.

  • Withdrawal of Antiepileptic Drugs: Gradually withdraw VIMPAT (over a minimum of 1 week) to minimize the potential of increased seizure frequency.

  • Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Also known as multi-organ hypersensitivity, has been reported with antiepileptic drugs. Some of these events have been fatal or life-threatening. If signs or symptoms are present, immediately evaluate the patient. Discontinue VIMPAT if an alternative etiology for the signs and symptoms cannot be established.

  • Risks in Patients with Phenylketonuria: VIMPAT oral solution contains aspartame, a source of phenylalanine which can be harmful in patients with phenylketonuria (PKU). A 200 mg dose of VIMPAT oral solution (equivalent to 20 mL) contains 0.32 mg of phenylalanine.

Adverse Reactions

  • Adjunctive therapy: In the adult placebo-controlled clinical trials, the most frequently seen adverse reaction with VIMPAT was dizziness (31% vs 8% placebo). Other common adverse reactions occurring in ≥10 percent of VIMPAT-treated patients, and greater than placebo, were headache, nausea, and diplopia.

  • Monotherapy: In the adult clinical trial, adverse reactions were generally similar to those observed and attributed to drug in adjunctive placebo-controlled trials, with the exception of insomnia (occurred at a higher rate of ≥2%).

  • Pediatric patients: Adverse reactions reported in clinical studies of pediatric patients 4 to less than 17 years of age were similar to those seen in adult patients.

  • Injection: In adult adjunctive therapy clinical trials, adverse reactions with intravenous administration generally were similar to those that occurred with the oral formulation, although intravenous administration was associated with local adverse reactions such as injection site pain or discomfort (2.5%), irritation (1%), and erythema (0.5%). When administering a loading dose, the incidence of CNS adverse reactions, such as dizziness, somnolence, and paresthesia may be higher with 15-minute administration than over a 30- to 60-minute period.

Dosing Considerations

VIMPAT injection is for intravenous and adult use only when oral administration is temporarily not feasible. The loading dose for adult patients should be administered with medical supervision considering the VIMPAT pharmacokinetics and increased incidence of CNS adverse reactions. The safety of VIMPAT injection and the use of a loading dose in pediatric patients have not been studied. Dosage adjustments are recommended for patients with mild or moderate hepatic impairment or severe renal impairment. Use in patients with severe hepatic impairment is not recommended. Perform dose titration with caution in all patients with renal and/or hepatic impairment.

VIMPAT is a Schedule V controlled substance.

Please see full Prescribing Information.

For more information on VIMPAT® contact 844-599-CARE (2273).