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99% of people with insurance are covered for VIVITROL®, including most government and commercial plans.1 Fill out the form below to see if your insurance can help cover the cost of VIVITROL. Once you submit this completed form, one of our Vivitrol2getherSM customer service specialists will contact you by email or phone to review your results.

All fields are required unless marked optional.
  • This form was created to help verify benefits with an insurance company. Unfortunately, if you do not have insurance or are paying with cash, you cannot complete this form.
    If you would like more information about the cost of VIVITROL, please reach out to a pharmacy of your choice and consider the VIVITROL® Co-pay Savings Program. Eligibility requirements apply.
All fields are required unless marked optional.
If there are multiple phone numbers on your insurance card, please provide the number found at the top of the phone number list.

We are unable to confirm your insurance benefits at this time.

Please review your personal and insurance information and try resubmitting. If you need help, please call 1-800-VIVITROL (1-800-848-4876), Monday–Friday, 9:00 AM–8:00 PM (ET), to speak with a customer service specialist.

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Are you a patient or a caregiver, and need help completing this form? Call 1-800-VIVITROL (1-800-848-4876), Monday–Friday, 9:00 AM–8:00 PM (ET).


LEARN ABOUT POSSIBLE SAVINGS ON YOUR VIVITROL PRESCRIPTION

Through the VIVITROL® Co-pay Savings Program, eligible patients can reduce their out-of-pocket costs.*

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Find a provider

Use the Provider Locator to find a healthcare provider near you who can discuss VIVITROL.

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VIVITROL is not right for everyone. There are significant risks from VIVITROL treatment, including risk of opioid overdose, severe reaction at the injection site, sudden opioid withdrawal, liver damage, or hepatitis.

Talk to your healthcare provider about naloxone, a medicine that is available to patients for the emergency treatment of an opioid overdose.

Call 911 or get emergency medical help right away in all cases of known or suspected opioid overdose, even if naloxone is administered.

If you are being treated for alcohol dependence but also use or are addicted to opioid-containing medicines or opioid street drugs, it is important that you tell your healthcare provider before starting VIVITROL to avoid having sudden opioid withdrawal symptoms when you start VIVITROL treatment.

See Important Safety Information.

See Prescribing Information and Medication Guide.


Reference: 1. Data on file. Alkermes, Inc. Waltham, MA.

*Terms and Conditions

Eligibility for Alkermes-Sponsored Co-pay Savings. This offer is only available to patients 18 years or older, with a prescription consistent with the Prescribing Information and the patient is not enrolled in, or covered by, any local, state, federal or other government program that pays for any portion of medication costs, including but not limited to Medicare, including Medicare Part D or Medicare Advantage plans; Medicaid, including Medicaid Managed Care and Alternative Benefit Plans under the Affordable Care Act; Medigap; VA; DOD; TRICARE; or a residential correctional program.

Additional Terms of Use: This offer is not conditioned on any past, present, or future purchase, including refills. Alkermes reserves the right to rescind, revoke, or amend this offer, program eligibility, and requirements at any time without notice. This offer is limited to one per patient, may not be used with any other offer, is not transferable and may not be sold, purchased or traded, or offered for sale, purchase or trade. Void where prohibited by law. Program Administrator or its designee will have the right upon reasonable prior written notice, during normal business hours, and subject to applicable law, to audit compliance with this program.


Reference: 1. Data on file. Alkermes, Inc. Waltham, MA.

*Terms and Conditions

Eligibility for Alkermes-Sponsored Co-pay Savings. This offer is only available to patients 18 years or older, with a prescription consistent with the Prescribing Information and the patient is not enrolled in, or covered by, any local, state, federal or other government program that pays for any portion of medication costs, including but not limited to Medicare, including Medicare Part D or Medicare Advantage plans; Medicaid, including Medicaid Managed Care and Alternative Benefit Plans under the Affordable Care Act; Medigap; VA; DOD; TRICARE; or a residential correctional program.

Additional Terms of Use: This offer is not conditioned on any past, present, or future purchase, including refills. Alkermes reserves the right to rescind, revoke, or amend this offer, program eligibility, and requirements at any time without notice. This offer is limited to one per patient, may not be used with any other offer, is not transferable and may not be sold, purchased or traded, or offered for sale, purchase or trade. Void where prohibited by law. Program Administrator or its designee will have the right upon reasonable prior written notice, during normal business hours, and subject to applicable law, to audit compliance with this program.