For Patients With Partial-Onset (Focal) Seizures
APPROVED FOR PATIENTS
AS YOUNG AS 1 MONTH OF AGE1
Veronica is an actual patient living with focal seizures.
BRIVIACT® (brivaracetam) CV is indicated for the treatment of partial-onset seizures in patients 1 month of age and older.
BRIVIACT is approved for pediatric patients 1 month of age and older.
Available in oral solution, tablets, and IV* formulations.1
*For use when oral administration is temporarily not feasible.1
Multiple Resources to Provide
Savings and Support for
BRIVIACT Patient Savings Program
Eligible Patients Pay As Little As $10 per 30-Day Supply of BRIVIACT With the BRIVIACT Patient Savings Program*
Ask your representative for details about the program.
- *Patients are responsible for a minimum of $10 out-of-pocket expense per 30-day supply. This card will be applied to any remaining out-of-pocket expense up to a maximum of $1300. Most patients who have commercial prescription insurance are eligible. If you have any questions regarding your eligibility or benefits or if you wish to discontinue your participation, call the BRIVIACT Savings Program at 1-888-786-5879 (8:30 AM – 5:30 PM EST, Monday-Friday and 8:30 AM – 2:30 PM EST, Saturday). This savings card is not valid for use by patients who are covered by any federally funded or state-funded healthcare program (including, but not limited to, Medicare [Part D and Medigap] and those who are Medicare-eligible and enrolled in an employer-sponsored health plan for retirees, Medicaid, any state pharmaceutical assistance program, TRICARE, VA, or DoD), or for cash-paying patients. Offer good only in the U.S., including Puerto Rico. This card is good for use only with a valid BRIVIACT prescription consistent with the approved FDA labeling 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.
- †Formularies can change and many health plans offer more than one formulary. Please check directly with the health plan to confirm coverage for individual patients.
UCB is committed to making BRIVIACT accessible for the majority of eligible patients across the US†
9 out of 10
commercial patients have formulary access to BRIVIACT2
Approximately 2/3 of patients across Commercial, Medicare, and Medicaid could have access to BRIVIACT first. This means they should not have to try and fail other anti-seizure medications, including generics, for their insurance to cover BRIVIACT.3†
When a prior authorization is required, CoverMyMeds® can provide assistance
CoverMyMeds offers prior authorization (PA) assistance through an electronic-based system that standardizes the medical necessity request process for most insurance providers and for patients with commercial, Medicare Part D, and Medicaid coverage*
Pharmacy-initiated PA requests
- If a prescription is submitted to a participating pharmacy and requires a PA, CoverMyMeds facilitates the approval process by delivering a PA to your office for completion, signature, and submission to the health plan
- More than 95% of retail pharmacies participate in CoverMyMeds5
- CoverMyMeds also offers a web-based portal that can help your office by automating the PA process, saving prescribers and staff time, and ensuring patients receive their medication faster
- *Currently, Medi-Cal, Washington State Medicaid, and Wisconsin State Medicaid require the pharmacy to submit prior authorization forms and may not be applicable to this program. This list is subject to change based on plan requirements.
- †Year-to-date average does not indicate or guarantee an individual’s approval for BRIVIACT.
Financial assistance may be available for BRIVIACT® patients
The BRIVIACT Patient Assistance Program may be able to help if your patients do not have health insurance or if they are a Medicare Part D recipient and cannot afford BRIVIACT.
To learn more about the BRIVIACT Patient Assistance Program or to find out if your patient might be eligible for assistance, please contact ucbCARES® at 1-844-599-CARE (2273) or ucbCARES@ucb.com, or click below to get started.