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 Access Pathways® at 1-877-788-4948.
VIGADRONE® Prescription Form >
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:
- 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.
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.