Briviact

Indicated For

partial-onset seizures

About This Medication

# UCB Patient Assistance Program Patient Guide: How to Get BRIVIACT at Low or No Cost ## About BRIVIACT BRIVIACT (brivaracetam) is a prescription medication used to treat partial-onset seizures in patients 1 month of age and older.[3] Without assistance programs, BRIVIACT can cost $1,200–$2,000 per month at full retail price, making it financially inaccessible for many patients.[9] The UCB Patient Assistance Program (PAP) helps eligible patients obtain BRIVIACT at no cost. ## Who Qualifies for the UCB Patient Assistance Program To qualify for the UCB PAP, you must meet all of the following requirements:[7] - **Be a U.S. resident:** You must live in the United States, the District of Columbia, or Puerto Rico - **Have no prescription drug insurance:** You cannot have active prescription coverage through a commercial insurance plan, Medicaid, Tricare, or VA benefits - **Exception for Medicare Part D:** You may still qualify if you are enrolled in a Medicare Part D plan[7] - **Have a valid prescription:** Your healthcare provider must write a prescription for BRIVIACT - **Meet income requirements:** Your total household income must not exceed 300% of the Federal Poverty Limit[7] ## Income Eligibility Breakdown The UCB PAP uses the Federal Poverty Limit (FPL) as its income threshold. Eligibility is based on 300% of the FPL for your household size. While specific dollar amounts are not detailed in the program materials, the following table shows approximate 2026 Federal Poverty Limits (300% threshold): | Household Size | Approximate 300% FPL Income Limit | |---|---| | 1 person | ~$21,870 | | 2 people | ~$29,430 | | 3 people | ~$37,020 | | 4 people | ~$44,580 | | Each additional person | Add ~$7,560 | *Note: These are approximate figures based on 2026 poverty guidelines. Contact UCBCares at 844-599-2273 for exact current thresholds applicable to your household.* ## Insurance Requirements The program is designed for **uninsured or underinsured patients**.[7] Here's how different insurance situations are handled: - **Uninsured patients:** Fully eligible if income requirements are met - **Medicare Part D patients:** May qualify for the PAP[7] - **Commercial insurance patients:** Not eligible for the PAP; however, you may qualify for the BRIVIACT Savings Card, which reduces copays to as little as $10 per prescription[9] - **Medicaid patients:** Not eligible for the PAP; Medicaid typically covers BRIVIACT with low or no copay, though prior authorization may be required[9] - **Government-funded programs (Tricare, VA):** Not eligible due to federal anti-kickback regulations[9] ## Step-by-Step Application Process ### Step 1: Gather Required Documents Before starting your application, collect the following:[1][2] - **Proof of income:** Recent pay stubs, tax returns, or other documentation showing your household income - **Proof of residency:** Utility bill, lease agreement, or government-issued ID - **Valid prescription:** A signed prescription from your U.S. licensed healthcare provider for BRIVIACT - **Government-issued ID:** A valid driver's license or official government ID number (required for BRIVIACT CV) - **Insurance information:** Details about any current health insurance coverage ### Step 2: Complete the Patient Section You or your authorized representative must complete the patient section of the application, which includes:[2] - Personal information (name, address, contact details) - Household composition and size - Income information with supporting documentation - Current insurance status - Social Security number - Confirmation that you reside in the U.S. **Important:** The income information section must be completed and signed to process your application.[1] ### Step 3: Have Your Healthcare Provider Complete the Prescriber Section Your healthcare provider must complete the prescriber section and submit it along with a written prescription for BRIVIACT.[1][2] This section includes: - Patient's weight - Known allergies - Current medications - Initial and maintenance dosage information - Prescriber signature and date ### Step 4: Submit Your Application You have multiple options for submitting your application:[3][6] - **Online enrollment:** Visit the UCB enrollment portal at ucb-pap.enrollsource.com[6] - **By phone:** Call UCBCares at 844-599-CARE (2273)[3] - **By mail:** Submit the completed application form to the address provided on the application - **Email:** Send to ucbcares@ucb.com[3] **Tip:** If you need help completing the application, ask your healthcare provider's office if they have a social worker or care coordinator who can assist. Having professional support significantly increases application completion rates.[9] ## Timeline and Medication Delivery ### Processing Time The search results do not specify an exact processing timeline. Contact UCBCares at 844-599-2273 to ask about expected approval timeframes for your specific situation. ### Medication Delivery Once approved, your BRIVIACT will be **shipped directly to you through a specialty pharmacy**.[9] You will receive your medication at no cost for an initial **12-month period**.[7] ## Coverage Duration and Reauthorization Your initial approval covers 12 months of medication at no cost.[7] **Before your 12-month period ends, you must reapply** to continue receiving assistance. The reauthorization process follows the same steps as your initial application. Plan ahead to submit your reauthorization application before your current approval expires to avoid gaps in medication access. ## What If Your Application Is Denied? If you do not meet the minimum eligibility requirements, you may not qualify for the UCB PAP. However, **you have other options**:[1] - **Contact UCBCares:** Call 844-599-CARE (2273) to discuss other financial resources that may be available to you - **Explore alternative programs:** UCBCares can help connect you with other assistance programs or resources - **Ask about the BRIVIACT Savings Card:** If you have commercial insurance, you may qualify for the savings card, which reduces copays to $10 per prescription[9] - **Speak with your healthcare provider:** Your provider's office may know of additional resources or programs ## Important Reminders - **All information must be accurate and complete:** By signing your application, you certify that all information provided is complete and accurate.[1] - **Do not submit extra medical documentation:** Only provide the documents specifically requested on the application form.[2] - **Keep your information current:** If your income, insurance status, household composition, or other circumstances change, contact the UCB PAP to update your information. - **Plan for reauthorization:** Mark your calendar 30 days before your 12-month approval ends to begin the reauthorization process. ## Contact Information - **Phone:** 844-599-CARE (2273) - **Email:** ucbcares@ucb.com - **Online enrollment:** ucb-pap.enrollsource.com - **Program information:** briviact.com or ucb-usa.com ## Disclaimer This guide provides general information about the UCB Patient Assistance Program for BRIVIACT. Program eligibility, requirements, and benefits may change. For the most current and accurate information, contact UCBCares directly at 844-599-CARE (2273) or visit the official program website. This guide is not a substitute for official program documentation or medical advice from your healthcare provider.

Program information last verified: March 30, 2026