Briviact Patient Assistance Programs

Briviact: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Briviact. Review the information to see if you qualify. The applications are available in Adobe PDF format and should be mailed directly to the provider of the patient assistance program.

If you have any questions, please call the telephone number for the program (not PharmacyChecker.com) or go to the program website.

Looking for a different medication?

UCBCares Program

(Program 1 of 1 — Scroll down to see them all )

Provided by: UCB, Inc.
1330 Enclave Parkway Suite 125 Houston, TX 77077
TEL: 844-599-2273
ALT PHONE: 844-599-2273
FAX: 855-880-5262
Languages Spoken:
English, Others By Translation Service
Program Website
Medications
  • Briviact (brivaracetam)
Eligibility Requirements
  • Insurance Status Uninsured or Underinsured with no prescription coverage
  • Those with Part D Elibible? Determined case by case
  • Income At or below 300% of FPL
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? Must reside in the US, District of Columbia, or Puerto Rico and have a prescription from a U.S. licensed doctor.
Application
  • Obtaining Call or download
  • Receiving Faxed or downloaded from website
  • Returning The completed application should be faxed back from the doctor's office.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Patient notified
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Amount requested is sent
  • Sent To Patient's home, unless otherwise noted
  • Delivery Time Not specified
  • Refill Proces Not specified
  • Limit Not specified
  • Re-application Once a year new application required. Financial documentation may be requested any time
Additional Information
CIMZIA: Call 1-866-424-6942 This program also provides copay assistance.
Updated November 27, 2018

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for prices here.

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