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Updated March 05, 2014
Viibryd

Forest Pharmaceuticals Patient Assistance Program

This program provides brand name medications at no or low cost.

Provided by: Forest Pharmaceuticals, Inc.

13645 Shoreline Drive
Earth City, MO 63045-1241

TEL: 800-851-0758


ALT PHONE:
FAX:
Languages Spoken:

English

Program Website
 

Patient Assistance Applications

Forest Pharmaceuticals Patient Assistance Program

 

Medications

  • Viibryd  Tablet 10mg, 20mg, 40mg (vilazodone)
  • Viibryd  Tablet; Titration Pack 10, 20, 40 mg combination pack (vilazodone)
 

Eligibility Requirements

Insurance Status May have insurance
Those with Part D Eligible? Determined case by case
Income Not disclosed
Diagnosis/Medical Criteria Not required
US Residency Required? Must have a social security number
   

Application

Obtaining Call or download
Receiving Faxed or mailed
Returning Mail
Doctor's Action Complete section, sign, attach prescription
Applicant's Action Complete section, sign, attach insurance information
Decision Communicated If denied, patient and Doctor notified
Decision Timeframe 2-4 weeks
   

Medication

Amount/Supply Up to 3 months supply
Sent To Doctor's office
Delivery Time Within 4 weeks
Refill Process New application and new prescription
Limit None
Re-application New application needed for each refill
   

Additional Information

The address on the prescription should match the mailing address on the application. If this is not the case, please attach letterhead to verify the delivery address. Eligibility determined on a case-by-case basis. Contact program for Spanish application.