Verify Insurance
Benefits

An important step in considering VIVITROL treatment includes finding out your insurance coverage for VIVITROL. Please fill out the form below, then one of our Vivitrol2gether customer service specialists will contact you by phone to review your results. If you do not wish to provide a phone number, we will contact you by email.

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.

Please enter your first name
Please enter your last name
Please enter your email address
Please choose one

INSURANCE INFORMATION

  • Insurance you get from your employer or purchase individually
    Please enter insurance company name
    • Please enter your policyholder name
    • Please enter your policyholder name
    • Please enter your policyholder name
    • Please enter your policyholder name
    Please choose one
    Please enter your coverage state
    Please enter your ID number
    If you have multiple phone numbers on your insurance card, please provide the number found at the top of the phone number list.
    Please enter your insurance company phone number
    Please enter group number
  • Please enter insurance company name
    Please enter your coverage state
    Please enter your ID number
    If you have multiple phone numbers on your insurance card, please provide the number found at the top of the phone number list.
    Please enter your insurance company phone number
    Please enter group number
    • Please enter your policyholder name
    • Please enter your policyholder name
    • Please enter your policyholder name
    • Please enter your policyholder name
    Please choose one
    Please enter your coverage state
    Please enter your ID number
    If you have multiple phone numbers on your insurance card, please provide the number found at the top of the phone number list.
    Please enter your insurance company phone number
    • Please enter your policyholder name
    • Please enter your policyholder name
    • Please enter your policyholder name
    • Please enter your policyholder name
    Please choose one
    Please enter your coverage state
    Please enter your ID number
    If you have multiple phone numbers on your insurance card, please provide the number found at the top of the phone number list.
    Please enter your insurance company phone number
  • Please enter insurance company name
    • Please enter your policyholder name
    • Please enter your policyholder name
    • Please enter your policyholder name
    • Please enter your policyholder name
    Please choose one
    Please enter your coverage state
    Please enter your ID number
    If you have multiple phone numbers on your insurance card, please provide the number found at the top of the phone number list.
    Please enter your insurance company phone number
    Please enter group number
  • Due to your selection, you are unable to complete this process as this service is to help verify benefits with an insurance company. 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.
Please choose one
Please enter your 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.