Get Vascepa

Completing the Vascepa savings program manual rebate form online is essential for obtaining reimbursement for your copayment or out-of-pocket expenses related to Vascepa. This guide will provide detailed instructions to ensure a smooth and successful process.

Follow the steps to complete the Vascepa rebate form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the patient information section. Include your first and last name, middle initial, address (address 1 and address 2), city, state, zip code, phone number, date of birth, email, gender, and age.
3. Next, complete the prescriber information section. Provide the prescriber’s first and last name, middle initial, address (address 1 and address 2), city, state, zip code, and phone number.
4. Ensure that you gather and attach the required documents before submission. You will need a copy of the Vascepa prescription label, a copy of the front of the Vascepa savings card, and a dated original receipt highlighting the amount of copayment or out-of-pocket expenses. Additionally, remember to provide your signature.
5. Review all completed sections for accuracy. Make sure all required fields are filled out properly. Check that your signature is included and that all documentation is attached.
6. Once all sections are complete and documents attached, save your changes. You may then download, print, or share the completed form as needed.

Complete your Vascepa rebate form online today to ensure you receive your reimbursement efficiently.