Pharmacy options, approval requirements, and the cost for VIVITROL prescriptions vary by health plan. Health plans typically cover VIVITROL as either a medical or pharmacy benefit. The Vivitrol2gether team can look into your patient’s health plan coverage and communicate insurer requirements.
How healthcare providers obtain VIVITROL usually depends on how it is covered by the patient’s health plan.
Network pharmacy: Some health plans allow any network pharmacy to fill VIVITROL.
Specialty pharmacy: Often, health insurers allow patients to obtain injectable medications through a specialty pharmacy. These pharmacies will obtain and ship a patient-specific prescription to your office. They bill the patient’s insurance directly and collect any co-pay from the patient. If a patient’s insurance covers VIVITROL under the medical benefit portion of the health plan, the plan may allow a network pharmacy to ship VIVITROL directly to the provider’s office and bill the patient’s health plan directly on behalf of the provider. Get information on insurer requirements and forms plus pharmacy options for fulfillment of VIVITROL from the Insurance and Pharmacy Navigator.
Buy and bill: Another option if VIVITROL is covered through the medical benefit is for the healthcare provider to buy units of VIVITROL from a specialty distributor and bill the patient’s insurance directly when it is administered. Buy and Bill Providers and the VIVITROL Co-pay Saving Program:
- You can directly submit a reimbursement request for your eligible patient’s co-pay or deductible expenses.
To enroll in the VIVITROL Co-pay Savings Program, set up an account with Opus Health/IQVIA. You have 2 options:
- Utilize the portal to register and submit claims at https://vivitrolbuyandbillcopay.opushealth.com.
- For assistance enrolling and navigating the portal, reference user guide.
- Submit paper claims by calling Opus Health/IQVIA at 1-877-838-3836.
WHEN WORKING WITH A SPECIALTY PHARMACY, Follow these steps with your patients to facilitate the delivery of VIVITROL to your office once a month.
The following steps provide an understanding of the ordering process for VIVITROL.
First VIVITROL prescription
- Determine the pharmacy options available based on the patient's health plan coverage. Information on pharmacy options for certain insurers may be found on the Insurance and Pharmacy Navigator
- Discuss the VIVITROL® Co-pay Savings Program with the patient; eligible patients can sign up and provide the required information to the pharmacy
- Remind your patients to expect a call from the pharmacy and/or coordinator to review important information about the first pharmacy order
Insurance, co-pay savings and prescription verification
- Specialty or other pharmacy performs a benefit verification on behalf of the patient and confirms prescription verification and prior authorization with the health plan
- Co-pay savings are applied for eligible patients
- Patient authorizes payment
Schedule shipping and delivery
- Patient is contacted to schedule or confirm delivery date
- Patient is called about next steps and follow-ups
Rx is filled and ready to ship
Pharmacy contacts patient and healthcare provider’s office to authorize shipment
- After patient authorization, pharmacy will contact your office to set up delivery
- Prescription is filled by pharmacy and shipped to your office
Delivery of VIVITROL
- Office receives VIVITROL
- Patient receives injection of VIVITROL
- Your patient’s follow-up appointment is scheduled
Follow-up for next injection
- Schedule follow-up appointment for the next injection
Vivitrol2gether is a customized patient support services program to help you and your patients in their recovery journey from opioid or alcohol dependence throughout fulfillment, transition of care, and during VIVITROL treatment.
Vivitrol2gether’s resources help support patient access:
- Specialty or other pharmacy selection options based on a patient’s health plan coverage
- Education about health plan and pharmacy requirements, including prior authorizations and coverage requirements
- Easy access to resources to help facilitate VIVITROL delivery
Explore the Vivitrol2gether patient support services and resources.View Patient Support Services
VIVITROL is not right for everyone. There are significant risks from VIVITROL treatment, including risk of opioid overdose, injection site reactions and sudden opioid withdrawal.
See Important Safety Information below. Discuss all benefits and risks with your patients. See Prescribing Information. Review Medication Guide with your patients.