STEP 1: Enroll Patient and Prescribe VIGADRONE®
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 >
VIGADRONE® Prescription Form
Download, print, complete and fax form to Access Pathways® at 1-877-788-4948.
VIGADRONE® Prescription Form >
STEP 2: WE CONFIRM AND VERIFY
We confirm both physician and patient Vigabatrin REMS Program requirements are complete. We also contact both you and the patient or caregiver to verify benefits and discuss next steps.
Our patient benefits verification determines:
If a patient is covered, a starter prescription will be shipped to the patient or caregiver and the prescription processed by a specialty pharmacy partner.
- PRIOR AUTHORIZATION
If a patient requires a prior authorization, we’ll contact their insurance provider and get the process going, as well as follow up with the physician and patient or caregiver to confirm the prior authorization is complete. Prior authorization support can be provided only for indicated disease states. If needed, we’ll also provide the patient with a bridge supply while the prior authorization is completed.
- NOT COVERED OR UNINSURED
If a patient is not covered or is uninsured, we have a cash option available.
- CO-PAY ASSISTANCE FOR ELIGIBLE PATIENTS
Medicare, Medicaid, and other state and federal health insurance care program patients are not eligible.
STEP 3: PRESCRIPTION DELIVERED
The prescription is processed by a specialty pharmacy partner and delivered to the patient or caregiver.
Access Pathways® Program Support
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
Visit the Vigabatrin REMS website for instructions, including Prescriber Certification, and the FDA-mandated REMS forms.