Vibativ Patient Assistance Programs

Vibativ: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Vibativ. 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 or go to the program website.

Looking for a different medication?

Theravance Biopharma Patient Assistance Program

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

Provided by: Theravance Biopharma
TEL: 855-847-9435
FAX: 855-847-9478
Languages Spoken:
English Others By Translation Service
Program Website
  • Vibativ 750 mg vial (telavancin 750 mg vial)
Eligibility Requirements
  • Insurance Status Must have no insurance or prescription coverage
  • Those with Part D Elibible? No
  • Income At or below 300% of FPL
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? Must be a legal resident of the United States or its territories
  • Obtaining Call or download
  • Receiving Faxed or mailed
  • Returning The completed application must be faxed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Call for information or inform doctor that he/she is in need
  • Decision Communicated Doctor notified
  • Decision Timeframe Within 1-2 business days
  • Amount/Supply Not applicable
  • Sent To Not applicable
  • Delivery Time Not applicable
  • Refill Proces Not applicable
  • Limit 2 incidents allowed per year
  • Re-application Doctor contacts company
Additional Information
Eligibility determined on a case-by-case basis.
Updated April 17, 2018

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

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