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Help Your Patients Save Money on Vimpat

You can help your patients save up to $360 on their prescription for Vimpat. With this Patient Savings Card, your patient pays the first $25 of the co-pay for Vimpat, and UCB will pay the remaining out-of-pocket expense up to $30. This Patient Savings Card for Vimpat is valid for 12 prescriptions over the course of 1 year.

Print out this page and give it to your qualifying patients who have been or are being prescribed Vimpat. Please do not cut out the card as important instructions for the pharmacist are included on the printed page.

Patient Instructions

To participate in the Vimpat Patient Savings Program, bring this page to the pharmacist along with your prescription for Vimpat. If you have any questions regarding your eligibility or benefits or if you wish to discontinue your participation, call the Vimpat Patient Savings Program at 1-800-657-7613 (8:00 AM - 8:00 PM EST, Monday-Friday).

Note: Do not lose this page. It carries a unique identification code and must be presented to the pharmacist for each prescription refill in order to receive your savings.

Print Page

Image: Vimpat (lacosamide) Patient Assistance Card powered by McKesson

RxBIN: 610524
RxPCN: Loyalty
RxGRP: 50775367
ISSUER: (80840)
ID: 325370078

Note: Please do not cut out the card as important instructions for your pharmacist are included on the printed page.

Eligibility Criteria

Most patients who have commercial prescription insurance can benefit from the Vimpat Patient Savings Program.
Patients receiving prescription reimbursement under Medicare, Medicaid, and similar federal or state programs are not eligible for this program. This includes patients who are enrolled in a Medicare Part D prescription drug program. Additionally, this program is not valid for residents of Massachusetts and where prohibited by law.

Pharmacist Instructions

Submit transaction to McKesson Specialty Arizona Inc. using BIN # 610524.
If primary coverage exists, input card information as secondary coverage and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response.
Acceptance of this card and your submission of claims for the Vimpat^® Patient Savings Program are subject to the LoyaltyScript^® program Terms and Conditions established by McKesson Specialty Arizona Inc. By accepting this card, you agree to the LoyaltyScript^® program Terms and Conditions posted at www.mckesson.com/mprs.
Patient is not eligible if prescriptions are paid in part or full by any state or federally funded programs, including but not limited to Medicare or Medicaid, Medigap, VA, DOD, or TriCare, and where prohibited by law. LoyaltyScript^® is not an insurance card.
For questions, call the Vimpat^® Patient Savings Program at 1-800-657-7613.

Indication

Vimpat^® (lacosamide) tablets and oral solution are indicated as adjunctive therapy in the treatment of partial-onset seizures in patients with epilepsy who are 17 years and older. Vimpat injection is indicated as short-term replacement when oral administration is not feasible in these patients.

Important Safety Information

Warnings and Precautions

AEDs increase the risk of suicidal behavior and ideation. Patients taking Vimpat should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior. Patients should be advised that Vimpat may cause dizziness, ataxia, and syncope. Caution is advised for patients with known cardiac conduction problems, who are taking drugs known to induce PR interval prolongation, or with severe cardiac disease. In patients with seizure disorders, Vimpat should be gradually withdrawn to minimize the potential of increased seizure frequency. Multiorgan hypersensitivity reactions have been reported with antiepileptic drugs. If this reaction is suspected, treatment with Vimpat should be discontinued.

Vimpat oral solution contains aspartame, a source of phenylalanine. A 200-mg dose of Vimpat oral solution (equivalent to 20 mL) contains 0.32 mg of phenylalanine.

Common Adverse Reactions

The most common adverse reactions occurring in ≥10 percent of Vimpat-treated patients, and greater than placebo, were dizziness, headache, nausea, and diplopia.

Dosage adjustments are recommended for patients with mild or moderate hepatic impairment or severe renal impairment. Use in severe hepatic impairment patients is not recommended.

Please see Vimpat Prescribing Information.