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Savings and Support

It is important to us that you have resources and partners that can help make getting VIGADRONE® as easy as possible. Upsher-Smith’s PROMISE OF SUPPORTTM Program offers a spectrum of patient assistance from enrollment in the Vigabatrin REMS Program and completion of the prescription form by the prescriber, to arrival of the first shipment of VIGADRONE®. We are here to help make the process as fast and smooth as possible.

From enrollment in the Vigabatrin REMS Program and completion of the prescription form by the prescriber, to arrival of the first shipment of VIGADRONE®, we are here to help make the process as fast and smooth as possible.

QUESTIONS?

Monday - Friday: 8am-8pm EST

Phone: 1-866-923-1954

Fax prescription forms:
1-877-788-4948

Weekends and after hours:
Fax prescription forms:
1-877-827-0395

HELPFUL DOWNLOADS:

VIGADRONE® PRESCRIPTION FORM >

Visit the Vigabatrin REMS website for instructions, including Prescriber Certification, and the FDA-mandated REMS forms.

Rems Website >

 

For Providers:

STEP 1: YOU ENROLL IN REMS AND PRESCRIBE VIGADRONE®

Complete the Vigabatrin Patient/Parent/Legal Guardian-Physician Agreement Form
Print, complete and fax form to the Vigabatrin REMS Program at 1-866-205-3072. Access form within the Prescriber Resources section.
REMS Form >

Complete the VIGADRONE® Prescription Form
Download, print, complete and fax form to 1-877-788-4948.
If you are sending on a WEEKEND or AFTER HOURS (8am-8pm EST) fax to: 1-877-827-0395.

VIGADRONE® Prescription Form >

Vigabatrin REMS

Visit the Vigabatrin REMS website for instructions, including Prescriber Certification, and the
FDA-mandated REMS forms.

REMS WEBSITE >

STEP 2: WE CONFIRM AND DETERMINE PATIENT COVERAGE

We confirm Step 1 is complete—that both physician and patient Vigabatrin REMS Program documents have been submitted.

We determine if the patient is:

  • Covered
  • Not covered or uninsured
  • Eligible for the co-pay assistance program
  • Or requires a prior authorization
    If the patient requires a prior authorization, we contact their insurance provider. We then fax all necessary forms to your office for you to complete. While this is being done, a VIGADRONE® starter/bridge supply is sent to the patient. Prior authorization support can be provided only for indicated disease states.

STEP 3: VIGADRONE® IS DELIVERED AND TREATMENT CAN BEGIN

Prescription ships to the patient from a specialty pharmacy partner as soon as enrollment and eligibility have been confirmed.

QUESTIONS?
MONDAY-FRIDAY: 8am-8pm EST Phone: 1-866-923-1954
Fax prescription forms: 1-877-788-4948

WEEKENDS AND AFTER HOURS:
Phone: 1-866-923-1954
Fax prescription forms: 1-877-827-0395