Verify Insurance
Benefits

An important step in starting your VIVITROL treatment includes finding out what your insurance will cover. As part of Vivitrol2gether, our customer service specialists will help. Please fill out the required fields in the form below. Once it has been completed, one of our customer service specialists will contact you by phone to review your results.

If you need help completing this form, call 1-800-VIVITROL (1-800-848-4876), Monday–Friday, 9am–8pm (EST), and a customer service specialist will assist you.

PATIENT INFORMATION

Please enter first name
Please enter last name
Please enter date of birth
Please enter email address
Please select primary diagnosis

INSURANCE INFORMATION

Please enter carrier name
Please enter policyholder name
Please select relationship with patient
Please enter state
Provide one of the following:
Please enter policy number
Please enter policy number
Please enter group number
Please enter Pharmacy Plan name

VIVITROL is not right for everyone. There are significant risks from VIVITROL treatment, including risk of opioid overdose, severe reaction at the injection site and sudden opioid withdrawal.
See Important Safety Information below. Discuss all benefits and risks with a healthcare provider. See Prescribing Information and Medication Guide.