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BRIVIACT® (brivaracetam) CV is a prescription medicine that can be used to treat partial-onset (focal) seizures in people 4 years of age and older. It is not known if BRIVIACT injection is safe for use in children. Children 4 years of age and older should only take BRIVIACT by mouth. BRIVIACT injection is only for use in people 16 years of age and older and may be given in the vein (intravenously) when BRIVIACT is not able to be taken by mouth. It is not known if BRIVIACT is safe and effective in children younger than 4 years of age. BRIVIACT® (brivaracetam) CV oral formulations are prescription medicines that can be used to treat partial-onset (focal) seizures in people 4 years of age and older.

Savings Registration

Save on your prescription
Eligible patients may pay as little as $20 per 30-day supply of BRIVIACT*

Follow these easy steps to save on your BRIVIACT prescription:

Savings card for BRIVIACT® (brivaracetam) CV
  • Check your eligibility
  • Register to activate your BRIVIACT Patient Savings Card
  • Present your card at the pharmacy to save on your prescription

Are you eligible for a BRIVIACT Patient Savings Card?

Eligibility criteria & terms apply. See complete Eligibility Criteria & Terms below.*

Please provide a response to all questions before checking your eligibility.

Which of the following best describes you?

Enter the patient’s date of birth

Is the patient currently a resident of the United States or Puerto Rico?

Is the patient currently enrolled in an employer-sponsored health plan for retirees, in a prescription drug benefit program for retirees, or in any state or federal health care program, including but not limited to Medicare, Medicaid, Medigap, VA, DOD, or TRICARE?

I certify that I am over the age of 18 and that I am the patient or that I am the patient’s caregiver or healthcare provider and have the patient’s consent to proceed with enrollment in the BRIVIACT Patient Savings Card Program. By proceeding with enrollment in the BRIVIACT Patient Savings Card Program, I certify that I or the patient meet the complete Eligibility Criteria & Terms below.

I understand that the information I provide, as well as information received from the pharmacy and/or OPUS Health, will be used by UCB and its affiliates and business partners in accordance with applicable laws.

 

Sorry, you are not eligible at this time.

  • This program is valid only for residents of the United States or Puerto Rico
  • 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.

Congratulations!

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.

ABOUT YOU

To be eligible for the BRIVIACT Savings Program, you must be a resident of the United States or Puerto Rico.
Select the statement that best describes you or the person you are representing (optional):
Are you or the person you are caring for taking (or going to be taking) BRIVIACT at the same time as another seizure treatment (optional)?

WAYS TO STAY INFORMED

Message and data rates may apply. Four (4) messages per month. Text “HELP” to 51590 for help. Text “STOPBRIV” to 51590 to stop all BRIVIACT messages. Text “STOP” to 51590 to stop all messages. See Terms and Conditions and Privacy Policy.

By submitting this form, you confirm that UCB has your permission to use your personal information to provide you with information and offers related to UCB on products, services and programs, and opportunities to participate in market research. You understand you may revoke your permission and participation in the program at any time by unsubscribing.

The information you provide will be used by UCB in accordance with our Privacy Policy and by parties acting on UCB’s behalf to send you information on BRIVIACT. View our Privacy Policy.

*See eligibility criteria & terms

Eligibility Criteria & Terms: This 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 $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: You must present this card to the pharmacist along with your valid BRIVIACT prescription to participate in the BRIVIACT Patient Savings Program. When you use this 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 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. 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 any questions regarding set up, claim transmission, patient eligibility, or other issues, 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).

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. Download the program instructions below to find out about eligibility requirements.

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.

Additionally, this download will help you get started:

Important Safety Information

What is BRIVIACT?

BRIVIACT® (brivaracetam) CV is a prescription medicine used to treat partial-onset seizures in people 4 years of age and older.

  • It is not known if BRIVIACT injection is safe for use in children.
  • Children 4 years of age and older should only take BRIVIACT by mouth.
  • BRIVIACT injection is only for use in people 16 years of age and older and may be given in the vein (intravenously) when BRIVIACT is not able to be taken by mouth.

It is not known if BRIVIACT is safe and effective in children younger than 4 years of age.

What is the most important information I should know about BRIVIACT?

BRIVIACT is a federally controlled substance (CV) because it can be abused or lead to dependence. Keep BRIVIACT in a safe place to prevent misuse and abuse. Selling or giving away BRIVIACT may harm others and is against the law.

Like other antiepileptic drugs, BRIVIACT may cause suicidal thoughts or actions in a very small number of people, about 1 in 500 people taking it.

Call a healthcare provider right away if you have any of these symptoms, especially if they are new, worse, or worry you:

  • thoughts about suicide or dying
  • attempts to commit suicide
  • new or worse depression
  • new or worse anxiety
  • feeling agitated or restless
  • panic attacks
  • trouble sleeping (insomnia)
  • new or worse irritability
  • acting aggressive, feeling angry, or being violent
  • acting on dangerous impulses
  • an extreme increase in activity and talking (mania)
  • other unusual changes in behavior or mood

Do not stop BRIVIACT without first talking to a healthcare provider.

  • Stopping BRIVIACT suddenly can cause serious problems.
  • Stopping a seizure medicine suddenly can cause seizures that will not stop (status epilepticus).

Who should not take BRIVIACT?

Do not take BRIVIACT if you are allergic to brivaracetam or any of the inactive ingredients in BRIVIACT.

What should I tell my healthcare provider before starting BRIVIACT?

Before taking BRIVIACT, tell your healthcare provider about all of your medical conditions, including if you:

  • have or have had depression, mood problems, or suicidal thoughts or behavior
  • have liver problems
  • have abused or been dependent on prescription medicines, street drugs, or alcohol
  • have any other medical problems
  • are pregnant or plan to become pregnant. It is not known if BRIVIACT will harm your unborn baby.
  • are breastfeeding or plan to breastfeed. It is not known if BRIVIACT passes into your breast milk.

What should I avoid while taking BRIVIACT?

Do not drive or operate heavy machinery until you know how BRIVIACT affects you. BRIVIACT may cause drowsiness, tiredness, dizziness, and problems with your balance and coordination.

What are the possible side effects of BRIVIACT?

BRIVIACT may cause serious side effects, including:

  • See “What is the most important information I should know about BRIVIACT?”
  • Nervous system problems. Drowsiness, tiredness, and dizziness are common with BRIVIACT, but can be severe. See “What should I avoid while taking BRIVIACT?” BRIVIACT can also cause problems with balance and coordination.
  • Mental (psychiatric) symptoms. BRIVIACT can cause mood and behavior changes such as aggression, agitation, anger, anxiety, apathy, mood swings, depression, hostility, and irritability. Irritability and anxiety are common with BRIVIACT, and can be severe. People who take BRIVIACT can also get psychotic symptoms such as hallucinations (seeing or hearing things that are really not there), delusions (false or strange thoughts or beliefs), and unusual behavior.

The most common side effects of BRIVIACT include:

  • sleepiness
  • dizziness
  • feeling tired
  • nausea and vomiting

Side effects of BRIVIACT in children 4 to less than 16 years of age are similar to those seen in adults.

These are not all the possible side effects of BRIVIACT. For more information, ask your healthcare provider or pharmacist. Tell your healthcare provider about any side effect that bothers you or that does not go away. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. You may also report side effects to UCB, Inc. at UCBCares® (1-844-599-CARE [2273]).

Please see additional patient information in the Medication Guide. This information does not take the place of talking with your healthcare provider about your condition or your treatment. For more information, go to www.BRIVIACT.com or call 1-844-599-2273.