Get Vascepa Savings Program

This guide provides a clear and supportive approach for users looking to complete the VASCEPA Savings Program manual rebate form online. It details each section of the form and offers step-by-step instructions to ensure the process is straightforward and efficient.

Follow the steps to complete the VASCEPA Savings Program rebate form.

1. Press the ‘Get Form’ button to access the rebate form and open it in the editor.
2. Carefully read the information regarding the collection of personal data required to process your request. Ensure you understand the privacy implications before proceeding.
3. Fill in the patient information section with accurate details, including your first name, middle name, last name, address, city, state, zip code, phone number, date of birth, email, gender, and age.
4. Complete the prescriber information section by providing the prescriber’s first name, middle name, last name, address, city, state, zip code, and phone number.
5. Prepare the additional required documents: a copy of the VASCEPA prescription label, a copy of the front of the VASCEPA Savings Card, and a dated original receipt with the amount highlighted.
6. Check the box to agree to the terms stating that you are over 18, you paid cash for your prescription, and that your prescription was not covered by state or federally funded programs.
7. Sign and date the form, certifying that the information provided is accurate.
8. Once you have filled out the form, save your changes, and print the completed document.
9. Submit the form and the required documents to the address provided: VASCEPA Savings Program, PO Box 2355, Morristown, NJ 07962.

Complete your VASCEPA Savings Program form online today for a smooth reimbursement process.