NAYZILAM nasal spray device

GET SAVINGS CARD

Start saving on your prescription

Follow the steps below to see if you're eligible* for a NAYZILAM® (midazolam) nasal spray, CIV savings card. Eligibility Criteria and Terms apply.

1 Check your eligibility
2 Register to activate your card
3 You're all set!

Are you eligible for a Nayzilam Patient Savings Card?

This form will help you find out. Fill out the requested information and choose the answers that best apply to you.

Registrant Type
Which of the following best describes you?
Enter the patient's date of birth
US Resident
Is the patient currently a resident of the United States or Puerto Rico?
Private Insurance
Does the patient currently have commercial insurance (also known as private insurance)?
Employer Insurance
Is the patient currently enrolled in an employer-sponsored health plan for retirees, in a prescription drug benefit program for retirees, or in any state or federal health care program, including but not limited to Medicare, Medicaid, Medigap, VA, DOD, or TRICARE?
Over 18
I certify that I am over the age of 18 and that I am the patient or that I am the patient’s caregiver or healthcare provider and have the patient’s consent to proceed with enrollment in the NAYZILAM Patient Savings Card Program. By proceeding with enrollment in the NAYZILAM Patient Savings Card Program, I certify that I or the patient meet the complete Eligibility Criteria and Terms below.
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I understand that the information I provide, as well as information received from the pharmacy and/or OPUS Health, will be used by UCB and its affiliates and business partners in accordance with applicable laws.

You are eligible to save on your NAYZILAM prescription.

Please fill out the registration form below to activate your NAYZILAM Patient Savings Card. It will only take you a minute.

If you are a caregiver, please fill out all information relevant to the patient you are representing.

All form fields are required unless otherwise noted.

First Name
Last Name
ZIP Code
ZIP Code The 5-digit ZIP code of your residential address.
Nayzilam Use Status
Select the statement that best describes you or the person you are representing:
Direct Mail Options
Other information you can request about NAYZILAM
Mailing Address
MAILING ADDRESS
By providing this information, you are representing that you are a U.S. resident at least 18 years old, and giving UCB and its business partners permission to send you information regarding your disease, as well as information on other related treatments, products and services, and for marketing and informational purposes. You understand that UCB or its business partners will not sell your name, address, email address, or any other information to another party for their own marketing use. You may remove yourself from the mailing list at any time by unsubscribing. View our privacy policy.

Eligibility Criteria and Terms: This savings card is not valid for use by patients who are covered by any federally funded or state-funded healthcare program (including, but not limited to, Medicare [Part D and Medigap] and those who are Medicare-eligible and enrolled in an employer-sponsored health plan for retirees, Medicaid, any state pharmaceutical assistance program, TRICARE, VA, or DoD), or for cash-paying patients. Offer good only in the U.S., including Puerto Rico. This card is good for use only with a valid NAYZILAM prescription consistent with the approved FDA labeling at the time the prescription is filled by the pharmacist and dispensed to the patient. The maximum annual benefit amount is $1200 per calendar year. Void where prohibited by law, taxed, or restricted. This offer cannot be combined with any other promotional offer. UCB, Inc. reserves the right to rescind, revoke, or amend this offer without notice at any time. No cash value. Not eligible for sale, purchase, trade, or counterfeit.

TO PATIENT: When you use this card, you are certifying that you meet the complete Eligibility Criteria and Terms and that you have not submitted, and will not submit, a claim for reimbursement under any federal, state or other governmental programs for this prescription. If you have any questions regarding the NAYZILAM Patient Savings Program or wish to discontinue your participation, please call 1-888-786-5879 (8:30 am – 5:30 pm ET, Monday – Friday and 8:30 am – 2 pm ET, Saturday).

TO PHARMACIST: Your acceptance of this card and your submission of claims for the NAYZILAM Patient Savings Program are subject to the Terms and Conditions established by OPUS Health. Submit the claim to the Primary Third-Party Payer first, then submit the balance due to OPUS Health as a Secondary Payer as a co-pay only billing using Other Coverage Code indication. You will receive the remaining balance, plus a handling fee, in your next reimbursement from OPUS Health. If you have questions, please contact the OPUS Pharmacy Support line at 1-888-786-5879.

Important Safety Information

Important Safety Information you should know about NAYZILAM® (midazolam) nasal spray, CIV

What is the most important information I should know about NAYZILAM?

NAYZILAM is a benzodiazepine medicine. Taking benzodiazepines with opioid medicines, alcohol, or other central nervous system depressants (including street drugs) can cause severe drowsiness, breathing problems (respiratory depression), coma, and death.

NAYZILAM may cause serious breathing problems and excessive sleepiness (sedation). Get emergency medical help right away if any of the following occur:

  • unusually shallow or slowed breathing
  • stop breathing, which may lead to your heart stopping
  • unusually excessive sleepiness

Like other antiepileptic drugs, NAYZILAM may cause suicidal thoughts or actions in a very small number of people, about 1 in 500. Call a healthcare provider right away if you have any of these symptoms, especially if they are new, worse, or worry you:

  • thoughts about suicide or dying
  • feeling agitated or restless
  • acting aggressive, being angry, or violent
  • attempts to commit suicide
  • panic attacks
  • acting on dangerous impulses
  • trouble sleeping (insomnia)
  • an extreme increase in activity and talking (mania)
  • new or worse anxiety
  • new or worse irritability
  • other unusual changes in behavior or mood

How can I watch for early symptoms of suicidal thoughts or actions?

  • Pay attention to any changes, especially sudden changes in mood, behaviors, thoughts, or feelings.
  • Keep all follow-up visits with your healthcare provider as scheduled.

Call your healthcare provider between visits as needed, especially if you are worried about symptoms. Suicidal thoughts or actions can be caused by things other than medicines. If you have suicidal thoughts or actions, your healthcare provider may check for other causes.

What is NAYZILAM?

  • NAYZILAM is a prescription medicine used for the short-term treatment of seizure clusters (also known as “acute repetitive seizures”) in patients 12 years of age and older.
  • NAYZILAM is a federal controlled substance (CIV) because it can be abused or lead to dependence. Keep NAYZILAM in a safe place to prevent misuse and abuse. Selling or giving away NAYZILAM may harm others and is against the law. Tell your healthcare provider if you have abused or been dependent on alcohol, prescription drugs, or street drugs.
  • It is not known if NAYZILAM is safe and effective in children under 12 years of age.

Do not use NAYZILAM if you:

  • are allergic to midazolam.
  • have an eye problem called acute narrow-angle glaucoma.

Before you use NAYZILAM, tell your healthcare provider about all your medical conditions, including if you:

  • have a history of depression, mood problems or suicidal thoughts or behavior.
  • have asthma, emphysema, bronchitis, chronic obstructive pulmonary disease, or other breathing problems.
  • have kidney or liver problems.
  • have congestive heart failure.
  • have a history of drug or alcohol abuse.
  • are pregnant or plan to become pregnant. NAYZILAM may harm your unborn baby.
  • are breastfeeding or plan to breastfeed. 

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins and herbal supplements. 

How should I use NAYZILAM?

  • Use NAYZILAM in the nose only.
  • Use NAYZILAM exactly as your healthcare provider tells you to use it and follow the Instructions for Use.
  • Your healthcare provider has prescribed NAYZILAM to treat a type of seizure called a “seizure cluster”.
  • If the seizure cluster is continuing 10 minutes after the first dose of NAYZILAM, a second dose of NAYZILAM may be used if you have been told to do so by your healthcare provider.
  • If a second dose of NAYZILAM is used, give the second dose in the other nostril.
  • Do not give more than 2 doses of NAYZILAM to treat a seizure cluster.
  • If the seizures do not stop after NAYZILAM is used, get emergency medical help right away.
  • Do not use NAYZILAM for more than one seizure cluster episode every 3 days. Do not use NAYZILAM for more than five seizure cluster episodes per month.
  • If benzodiazepines are stopped after a person takes them daily, they can cause withdrawal symptoms. Stopping benzodiazepines suddenly can cause seizures that will not stop (status epilepticus), hearing or seeing things that are not there (hallucinations), shaking, nervousness, and stomach and muscle cramps. NAYZILAM is not intended to be taken daily.
  • If you use too much NAYZILAM, call your healthcare provider or go to the nearest emergency room right away.

What should I avoid while using NAYZILAM?

  • Do not drive, operate machinery, or do other activities that require mental alertness until you know how NAYZILAM affects you.
  • Do not drink alcohol or take opioid medicines or other medicines that make you sleepy or dizzy while taking NAYZILAM until you talk to your healthcare provider. 

What are the possible side effects of NAYZILAM? 

NAYZILAM may cause serious side effects, including:

  • See “What is the most important information I should know about NAYZILAM?” for information on serious side effects of:
    • interaction with other central nervous system depressants
    • serious breathing problems and excessive sleepiness
    • suicidal thoughts or actions
  • Impaired mental alertness including memory problems. See “What should I avoid while using NAYZILAM?
  • Increase in eye pressure in people with acute narrow-angle glaucoma. See “Do not take NAYZILAM if you:

The most common side effects of NAYZILAM include:

  • sleepiness
  • headache
  • runny nose
  • nasal discomfort
  • throat irritation

These are not all the possible side effects of NAYZILAM. Call your doctor for medical advice about side effects. 

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088, or you may contact ucbCARES® at 1-844-599-CARE.

Please see additional patient information in the Medication Guide. This information does not take the place of talking with your healthcare provider about your condition or your treatment. For more information, go to www.NAYZILAM.com or call 1-844-599-2273.

Please talk to your healthcare provider if you have any questions or concerns about NAYZILAM.

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SELECT IMPORTANT SAFETY INFORMATION

NAYZILAM is a benzodiazepine medicine. Taking benzodiazepines with opioid medicines, alcohol, or other central nervous system depressants (including street drugs) can cause severe drowsiness, breathing problems (respiratory depression), coma, and death. NAYZILAM may cause serious breathing problems and excessive sleepiness (sedation). Like other antiepileptic drugs, NAYZILAM may cause suicidal thoughts or actions. Do not use NAYZILAM if you have an eye problem called acute narrow-angle glaucoma. Do not drive, operate machinery, or do other activities that require mental alertness until you know how NAYZILAM affects you. The most common side effects of NAYZILAM include sleepiness, nasal discomfort, headache, throat irritation and runny nose.

SELECT IMPORTANT SAFETY INFORMATION

NAYZILAM is a benzodiazepine medicine. Taking benzodiazepines with opioid medicines, alcohol, or other central nervous system depressants (including street drugs) can cause severe drowsiness, breathing problems (respiratory depression), coma, and death.