If your pharmacy was unable to process your co-pay card or free trial
voucher, please download and print the appropriate form below.
Please complete and return along with your prescription receipt to:

OPUS Health, a Division of IMS Health
77 Corporate Drive

Bridgewater, NJ 08807

 Download Rebate Fulfillment Form (all other programs) (requires acrobat reader) [Download Acrobat]

 Download Vivitrol Rebate Fulfillment Form (requires acrobat reader) [Download Acrobat]

  Download Mayzent Medical Claim Reimbursement Request Form (requires acrobat reader) [Download Acrobat]

 Download Mayzent Pharmacy Claim Reimbursement Request Form (requires acrobat reader) [Download Acrobat]

Due to federal laws, it is important that you send your prescription receipt and not your register receipt. See a picture of a prescription receipt.

If you have any other questions, please call us at (800)364-4767 or email us at OpusProgramSupport@quintilesims.com