VIBERZI® SAVINGS PROGRAM
Activation

Please enter in the correct format: MM/DD/YYYY

Please enter your first name so we may contact you.

Please enter your last name so we may contact you.

Please enter your ZIP code.

Please ensure your email address is in the correct format: user@domain.com

viberzi-logo
Activation

This field is required. Please make a selection.

This field is required. Please make a selection.


This field is required. Please make a selection.

This field is required. Please make a selection.

viberzi-logo

By activating your card, you certify that the information provided above is true and correct and that you are not enrolled in a federal- or state-funded prescription drug benefit program, such as Medicare or Medicaid, or any private indemnity or HMO insurance plan that reimburses you for the entire cost of your prescription drugs. You also certify that you are not Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees. You further certify that should you begin receiving prescription benefits from one of these types of programs at any time, you will no longer participate in this savings program.

This field is required. Please make a selection.

For those individuals without a card, click here for full Program Terms, Conditions, Eligibility Criteria.

*Offer not valid for patients enrolled in Medicare, Medicaid, or other federal or state healthcare programs. Maximum savings limit applies; patient out-of-pocket expense may vary. Click here for full Program Terms, Conditions, Eligibility Criteria.

{"crx-wl-channel":"web","crx-wl-survey-description":"Agreement Certification","crx-wl-survey-name":"Viberzi Patient Survey v1.0.0","groupNumber":"EC48016020","brandName":"viberzi","client":"allergan","brand":"viberzi","brandPath":"viberzi","view":"activation"}