VIMPAT Support Program

Jeff K. is a real VIMPAT patient.

Activate My Savings Card

If you already have the VIMPAT Patient Savings Card, answer a few questions to check your eligibility and activate it now.

Savings card for VIMPAT® (lacosamide) CV

Are you eligible for a VIMPAT Patient Savings Card?

Eligibility criteria & terms apply. See complete Eligibility Criteria & Terms below.*

Please provide a response to all questions before checking your eligibility.

Which of the following best describes you?

Enter the patient’s date of birth

Is the patient currently a resident of the United States or Puerto Rico?

Is the patient currently enrolled in an employer-sponsored health plan for retirees, in a prescription drug benefit program for retirees, or in any state or federal health care program, including but not limited to Medicare, Medicaid, Medigap, VA, DOD, or TRICARE?

I certify that I am over the age of 18 and that I am the patient or that I am the patient’s caregiver or healthcare provider and have the patient’s consent to proceed with enrollment in the VIMPAT Patient Savings Card Program. By proceeding with enrollment in the VIMPAT Patient Savings Card Program, I certify that I or the patient meet the complete Eligibility Criteria & Terms below.

I understand that the information I provide, as well as information received from the pharmacy and/or OPUS Health, will be used by UCB and its affiliates and business partners in accordance with applicable laws.

 

Sorry, you are not eligible at this time.

  • This program is valid only for residents of the United States or Puerto Rico
  • Patients are not eligible if their prescriptions are paid in part or in 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
  • Patients must be 4 years of age or older

For more information, call us at 1-844-599-CARE (2273), Monday through Friday, 8AM to 8PM EST.

Congratulations!

You’re eligible to save on your VIMPAT prescription. Please fill out the registration form below to activate your VIMPAT Patient Savings Card. It will only take you a few minutes.

If you are a caregiver, please fill out all information relevant to the patient you are representing.

ABOUT YOU

Are you, or the person you care for, currently taking VIMPAT or do you/they have an unfilled prescription? (optional)
Gender (optional)

WAYS TO STAY INFORMED

RECEIVE YOUR FREE VIMPAT WELCOME KIT
Your FREE Welcome Kit includes patient information and resources to help you get started on VIMPAT.

GET UPDATES VIA TEXT MESSAGE

Sign up to receive your VIMPAT Savings Card, refill reminders, and other updates via text message.

Message and data rates may apply. Four (4) messages per month. Text “HELP“ to 51590 for help. Text “STOPVIM“ to 51590 to stop all VIMPAT messages. Text “STOP“ to 51590 to stop all messages. See Terms and Conditions and Privacy Policy.

Please ensure the phone number you enter is a mobile number.

By submitting this form, you confirm that UCB has your permission to use your personal information to provide you with information and offers related to UCB on products, services and programs, and opportunities to participate in market research. You understand you may revoke your permission and participation in the program at any time by unsubscribing.


VIMPAT is a registered trademark used under license from Harris FRC Corporation. All other trademarks are the property of their respective owners.
*See Eligibility Criteria & Terms

Eligibility Criteria & Terms: This savings card is not valid for use by patients who are covered by any federal or state funded healthcare program (including, but not limited to, Medicare [Part D and Medigap], Medicaid, any state pharmaceutical assistance program, TRICARE, VA, or DoD). Offer good only in the U.S., including Puerto Rico. This card is good for use only with a valid VIMPAT prescription at the time the prescription is filled by the pharmacist and dispensed to the patient. The maximum annual benefit amount is $1300 per calendar year. Void where prohibited by law, taxed, or restricted. This offer cannot be combined with any other promotional offer. UCB, Inc. reserves the right to rescind, revoke, or amend this offer without notice at any time. No cash value. Not eligible for sale, purchase, trade, or counterfeit.

TO PATIENT: You must present this card to the pharmacist along with your valid VIMPAT prescription to participate in the VIMPAT Patient Savings Program. When you use this card, you are certifying that you have not submitted and will not submit a claim for reimbursement under any federal, state or other governmental programs for this prescription. If you have any questions regarding the VIMPAT Patient Savings Program or wish to discontinue your participation, please call 1-888-786-5879 (8:30 am – 5:30 pm ET, Monday – Friday and 8:30 am – 2 pm ET, Saturday).

TO PHARMACIST: Your acceptance of this card and your submission of claims for the VIMPAT Patient Savings Program are subject to the Terms and Conditions established by OPUS Health. For patients with insurance: Submit the claim to the Primary Third Party Payer first, then submit the balance due to OPUS Health as a Secondary Payer as a co-pay only billing using Other Coverage Code indication. You will receive the remaining balance, plus a handling fee, in your next reimbursement from OPUS Health.

VIMPAT Patient Assistance Program

UCB, the maker of VIMPAT, remains committed to helping epilepsy patients gain access to the medicines we manufacture. The VIMPAT Patient Assistance Program may be able to help if you do not have health insurance or if you are a Medicare Part D recipient and cannot afford your VIMPAT medicine.

The VIMPAT Patient Assistance Program may provide medication at no cost to eligible patients who are unable to pay for their VIMPAT prescription. Download the program instructions below to find out about eligibility requirements.

To find out if you might be eligible for assistance, please call our customer service team at 1-844-599-CARE (2273) or UCBCares@ucb.com to learn more about the VIMPAT Patient Assistance Program. Additionally, this download will help you get started: