Have them present the BRIVIACT Patient Savings Card to the pharmacy when filling their prescription
To learn more about card set up, claim transmission, patient eligibility, and more, call OPUS Health for the BRIVIACT Patient Savings Program at 1-888-786-5879 (8:30 am – 5:30 pm ET, Monday – Friday and 8:30 am – 2 pm ET, Saturday).
TERMS AND CONDITIONS
Eligibility Criteria & Terms: The 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 BRIVIACT prescription at the time the prescription is filled by the pharmacist and dispensed to the patient. The maximum annual benefit amount is $1,300 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. The card is good for 12 uses.
TO PATIENT: You must present the card to the pharmacist along with your valid BRIVIACT prescription to participate in the BRIVIACT Patient Savings Program. When you use the 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 the prescription. If you have any questions regarding the BRIVIACT 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 the card and your submission of claims for the BRIVIACT 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.
For patients without insurance (cash pay): Please submit this claim to OPUS Health, a division of IMS Incorporated. A valid Other Coverage Code is required. Eligible patients can expect to save up to $100 per 30-day supply and you will receive this amount in your reimbursement from OPUS Health, plus a handling fee.