Activate My Savings Card
Are you eligible for a BRIVIACT Patient Savings Card?
Eligibility criteria and terms apply. See complete Eligibility Criteria and Terms below.*
Sorry, you are not eligible at this time.
- This program is valid only for residents of the United States or Puerto Rico
- This program is not available for patients without commercial insurance
- Patients are not eligible if their prescriptions are paid in part or in full by any state or federally funded programs, including but not limited to Medicare or Medicaid, Medigap, VA, DOD, or TRICARE, and where prohibited by law
- Patients must be 4 years of age or older
For more information, call us at 1-844-599-CARE (2273), Monday through Friday, 8AM to 8PM EST.
You’re eligible to save on your BRIVIACT prescription. Please fill out the registration form below to activate your BRIVIACT Patient Savings Card. It will only take you a minute.
If you are a caregiver, please fill out all information relevant to the patient you are representing.
Eligibility Criteria and Terms: 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 US, including Puerto Rico. This card may only be used 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.
TO PATIENT: When you use this card, you are certifying that you meet the complete Eligibility Criteria and Terms and that you have not submitted, and will not submit, a claim for reimbursement under any federal, state or other governmental programs for this 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 this card and your submission of claims for the BRIVIACT Patient Savings Program are subject to the Terms and Conditions established by OPUS Health. 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.
BRIVIACT Patient Assistance Program
UCB, the maker of BRIVIACT, remains committed to helping epilepsy patients gain access to the medicines we manufacture. The BRIVIACT Patient Assistance Program may be able to help if you do not have health insurance or if you are a Medicare Part D recipient and cannot afford your BRIVIACT medicine.
The BRIVIACT Patient Assistance Program may provide medication at no cost to eligible patients who are unable to pay for their BRIVIACT prescription.
To find out if you might be eligible for assistance, please call ucbCARES® at 1-844-599-CARE (2273) or email ucbCARES@ucb.com to learn more about the BRIVIACT Patient Assistance Program.
Get started by reviewing the program instructions and filling out the application form.