Horizon Pharma Patient Assistance Program
How to Apply
One Phone Call Will Get You Started
or click to access the Patient
Assistance Program Application
for your application
Monday-Friday, 8:00 AM
to 5:00 PM, Central Standard Time
on your application form
Submit the completed application
by mail or fax
to the address provided*
*Your application must be signed by both you and your physician. Prescriptions will be sent to your home address, pending approval of your application. Please see eligibility requirements.
Making It Easier to Get Your Medicine
At Horizon Pharma, the maker of VIMOVO, we believe that it is important for patients like you to be able to get the medicine your doctor has prescribed. However, we understand it can be difficult to pay if you are uninsured or underinsured.
If you are unable to afford a Horizon Pharma product that has been prescribed to you, the Horizon Pharma Patient Assistance Program can help.
For more information about the Horizon Pharma Patient Assistance Program, please call 1-888-958-5502 or click to access the Patient Assistance Program Application.
Eligibility Requirements for the Horizon Pharma Patient Assistance Program
- You must be a US resident with a valid Social Security number
- You are currently uninsured or underinsured as defined by the program
- Your annual household income should be at or below 300% of the current Federal Poverty Level