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How to use or fill out the Co-pay Savings Program Patient Mail-in Form for VIVITROL® with our platform
Ease of Setup
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Ease of Use
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Click ‘Get Form’ to open it in the editor.
Begin by completing the Patient Information Section at the bottom of the form. Fill in your last name, first name, Rx Group number, Rx ID number, street address, city, state, zip code, phone number, and email.
Gather and attach the required documents: a copy of the co-pay card offer, an Explanation of Benefits (EOB) form for insured patients, an itemized cash receipt for self-pay patients, a Payer-Specific Insurance Billing Form (CMS-1500), and proof of payment for the injection.
Review all filled sections and attached documents to ensure accuracy before mailing.
Mail the completed form along with all requested documentation to OPUS Health at the specified address.
Start using our platform today to simplify your document editing and submission process!
Fill out ( for extended-release ... - OPUS Health online It's free
The variable copay program applies to a select list of 200 drugs representing more than 90% of the copay assistance available today when dispensed through Optum Specialty Pharmacy. With Optum Rx variable copay, the maximum annual coupon assistance is spread over 12 months and sets the members cost share.
What is Opus Health Copay Assist?
What is the purpose of opus health copay assistance? The purpose of Opus Health Copay Assistance is to provide financial assistance to patients who are struggling to pay their copayments for prescription medications. It helps patients afford their medications by providing assistance with copay costs.
How much is VIVITROL out of pocket?
The cost for Vivitrol 380 mg intramuscular powder for injection, extended release is around $1,774 for a supply of 1 powder for injections, depending on the pharmacy you visit. Quoted prices are for cash-paying customers and are not valid with insurance plans.
What is Opus copay assistance?
Opus Health Copay Assistance is a program designed to provide financial assistance to eligible individuals who are having difficulty affording their copayments for covered medications. The program provides a copay card or voucher that can be used to help cover the cost of prescriptions.
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