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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 Support® 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.

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

As soon as enrollment and eligibility have been confirmed, the prescription ships to the patient from our specialty pharmacy partner.

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