aCurrent as of September 2024.
99% OF PEOPLE WITH ANY INSURANCE (INCLUDING MEDICAID) ARE
Filling a VIVITROL prescription
Pharmacy options, approval requirements, and the cost for VIVITROL prescriptions vary by health plan. Health plans can cover VIVITROL as either a medical or pharmacy benefit.
How healthcare providers obtain VIVITROL usually depends on how it is covered by the patient’s health plan. Get information on insurer requirements and forms plus pharmacy options for fulfillment of VIVITROL from the Insurance and Pharmacy Navigator.
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Retail pharmacy: Some health plans allow any network pharmacy to fill VIVITROL.
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Specialty pharmacy: These pharmacies will obtain and ship a patient-specific prescription to your office. If a patient’s insurance covers VIVITROL under the medical benefit portion of the health plan, the plan may allow a network pharmacy to ship VIVITROL directly to the provider’s office and bill the patient’s health plan directly on behalf of the provider. The Vivitrol2gether® team can work with offices to send prescriptions to pharmacies based on their patients' healthcare plan requirements. Link to Vivitrol2gether Enrollment Form on previous page.
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Buy and bill: Another option if VIVITROL is covered through the medical benefit is for the healthcare provider to buy units of VIVITROL from a specialty distributor and bill the patient’s insurance directly when it is administered.
Buy-and-bill providers and the VIVITROL Co-pay Savings Program:
- If you set up an account with IQVIA, you can directly submit a reimbursement request for your eligible patient’s co-pay or deductible expenses
- To enroll in the VIVITROL Co-pay Savings Program, set up an account with IQVIA. You have 3 options:
- Utilize the portal to register and submit claims at
https://VIVITROLbuyandbillcopay.opushealth.com - Read the Buy & Bill Portal Guide to Co-pay assistance reimbursement
- Submit paper claims by calling IQVIA at 1-877-838-3836
- Utilize the portal to register and submit claims at
Obtaining VIVITROL through a specialty pharmacy
- How you obtain VIVITROL depends on how it is covered by the patient’s health plan. Often, health insurers require injectable medications to be filled through designated specialty pharmacies
- Specialty pharmacies obtain and ship a patient-specific prescription to the healthcare provider’s office. Specialty pharmacies bill the patient’s insurance directly and collect any co-pay from the patient
Getting patients started on VIVITROL via specialty pharmacy fulfillment
The healthcare provider’s office:
- Completes the specialty pharmacy form. If using Vivitrol2gether Patient Support Services, both the healthcare provider office and patient must fill out the appropriate sections of the Patient Enrollment Form.
- If submitting directly to the specialty pharmacy, consults Insurance and Pharmacy Navigator and fills out the pharmacy’s form or the Vivitrol2gether Patient Enrollment Form
- Provides front and back of patient’s medical and pharmacy insurance cards (if patient has both)
- Explains the availability of the VIVITROL Co-pay Savings Program for eligible patients
- Sends the specialty pharmacy form to the specialty pharmacy
- Returns the specialty pharmacy’s call to confirm shipment date
The specialty pharmacy:
- Confirms insurance coverage with the patient’s health plan
- Finds out what the patient’s insurance covers
- Applies any co-pay program savings for which the patient is eligible
- May provide additional support services for patient continuity of care
Patients should expect a call from the specialty pharmacy to coordinate the delivery of their prescription to the healthcare provider’s office.