Long-Acting Injectable (LAI) Medication

LAIs include Vivitrol, Haldol Decanoate, Prolixin Decanoate, Risperdal Consta, Invega Sustenna, Abilify Maintena, and Zyprexa Relprevv.

• BriovaRx Enrollment Form: Complete this interactive PDF form and send to BriovaRx to initiate this program for eligible members
  • Static PDF BriovaRx Enrollment Form: Complete and send to BriovaRx to initiate this program for eligible members
  • UnitedHealthcare California HMO BriovaRx Enrollment Form: Complete and send to Optum to initiate this program for eligible members
• LAI Program Introduction: Brief introduction to the program and other materials posted here
• LAI Attestation Form: Complete this form to have the LAI specialty added to your provider file
• LAI Flyer
• Quick Reference Guide LAI and BriovaRx: One-page highlights of the program and how it works
• Pharmacological Information
• LAI Studies: Summary of multiple studies related to use of Long–Acting Injectable Medications