Rebate For Your Mail-Order VIIBRYD® PrescriptionsTake advantage of these savings. The VIIBRYD Savings Program is valid toward out-of-pocket expenses for commercially insured patients filling a VIIBRYD prescription.

*Terms and Conditions

Program Terms, Conditions, and Eligibility Criteria: 1. This offer is valid only for patients 18 years of age or older and is good for use only with a valid prescription for VIIBRYD® (vilazodone HCl) 10 mg, 20 mg, and/or 40 mg or one Patient Starter Kit at the time the prescription is filled by the pharmacist and dispensed to the patient. 2. Depending on your insurance coverage, most eligible patients may pay as little as $15 per 30-day supply for each up to six (6) prescription fills OR 60-day supply for each of up to three (3) prescription fills OR per 90-day supply for each of up to two (2) prescription fills. Check with your pharmacist for your copay discount. Maximum savings limit applies; patient out-of-pocket expense may vary. 3. This card is not valid for use by patients enrolled in Medicare, Medicaid, or other federal or state programs (including any state pharmaceutical assistance programs), or private indemnity or HMO insurance plans that reimburse you for the entire cost of your prescription drugs. Patients may not use this card if they are Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees. This offer is not valid for cash-paying patients. 4. Each card is valid for up to six (6) prescription fills of a 30-day supply each OR up to three (3) prescription fills of a 60-day supply each OR up to two (2) prescription fills of a 90-day supply each. Offer applies only to prescriptions filled before the program expires on December 31, 2019. 5. Allergan reserves the right to rescind, revoke, or amend this offer without notice. 6. Offer good only in the USA, including Puerto Rico, at participating retail pharmacies. 7. Void if prohibited by law, taxed, or restricted. 8. This card is not transferable. The selling, purchasing, trading, or counterfeiting of this card is prohibited by law. 9. This card has no cash value and may not be used in combination with any other discount, coupon, rebate, free trial, or similar offer for the specified prescription. 10. This offer is not health insurance. 11. This card expires December 31, 2019. 12. By redeeming this card, you acknowledge that you are an eligible patient and that you understand and agree to comply with the terms and conditions of this offer.

Please visit www.Viibryd.com for full Prescribing Information, including Boxed Warning, and Medication Guide.

Here’s how to save:

Fill your prescription for VIIBRYD through your licensed mail-order pharmacy in the United States.

Fill out the form on page 2.

Include the following:

• A photocopy of the front and back of your VIIBRYD Savings Card.

• Your original proof of purchase (original pharmacy receipt with your name and address, pharmacyname, product name, prescription numbers, NDC number, date filled, quantity, and price).

• Photocopy of the front and back of your insurance card used for this claim (if you did not usecommercial insurance, you are ineligible for reimbursement).

Mail it in.

VIIBRYD Savings Cardc/o PSKW, PO Box 7017Bedminster, NJ 07921-7017.Please allow 6-8 weeks to process your rebate.

Mail-Order Rebate Fill out the information below to apply for your prescription rebate.

Patient Information

Full name

Date of Birth Month Day Year

Address

City State

ZIP Code Phone

Email

By signing below:• I verify that the information provided on this form is complete and accurate.

• I understand that my rebate is subject to the Terms and Conditions established by Allergan and that Allergan reservesthe right at any time, or for any reason, and without notice to modify or discontinue the mail-order rebate program.

• I authorize Allergan, Inc., and ConnectiveRx to use the information I provide for processing rebates.

• I further certify that: (1) This prescription was submitted to my insurer and that I paid my coinsurance or copay requiredby my insurer for this prescription; (2) I will comply with the terms of my health insurance contract, if any, requiringnotification to my payer of the existence and/or value of this rebate; (3) I am not enrolled in Medicare, Medicaid, orother federal or state programs (including any state pharmaceutical assistance programs), or private indemnity or HMOinsurance plans that reimburse you for the entire cost of your prescription drugs; and (4) I meet the eligibility criteria andwill comply with the terms and conditions described in the program Terms and Conditions.

Mail your completed form and original or photocopied mail-order pharmacy receipt to: VIIBRYD Savings Cardc/o PSKW, PO Box 7017Bedminster, NJ 07921-7017.

Allergan® and its design are trademarks of Allergan, Inc. VIIBRYD® and its design are registered trademarks of Allergan Sales, LLC. © 2019 Allergan. All rights reserved.

Patient Signature: __________________________________________________ (Required)

For additional information about VIIBRYD, call Allergan Medical Information toll-free at 1-800-678-1605.

Please visit www.Viibryd.com for full Prescribing Information, including Boxed Warning, and Medication Guide

Brief Summary of Important Risk InformationVIIBRYD® [vī-brid](vilazodone hydrochloride) tabletsThis information does not take the place of talking to your healthcare provider about your medical condition or your treatment.

What is VIIBRYD?VIIBRYD is a prescription medicine used to treat a certain type of depression called Major Depressive Disorder (MDD). It is important to talk with your healthcare provider about the risks of treating depression and also the risk of not treating it. You should discuss all treatment choices with your healthcare provider. Talk to your healthcare provider if you do not think that your condition is getting better with VIIBRYD treatment.

What is the most important information I should know about VIIBRYD?VIIBRYD and other antidepressant medicines may cause serious side effects. Call your healthcare provider right away if you have any of the following symptoms, or call 911 if there is an emergency:1. Suicidal thoughts or actions: VIIBRYD

and other antidepressant medicines mayincrease suicidal thoughts or actions in some people 24 years of age and younger, especiallywithin the first few months of treatment orwhen the dose is changed. Depression orother serious mental illnesses are the mostimportant causes of suicidal thoughts oractions. Watch for these changes and call yourhealthcare provider right away if you noticenew or sudden changes in mood, behavior,actions, thoughts, or feelings, especially if severe. Pay particular attention to suchchanges when VIIBRYD is started or whenthe dose is changed. Keep all follow-up visits with your healthcare provider and call betweenvisits if you are worried about symptoms.Call your healthcare provider right awayif you have any of the following symptoms, especially if they are new, worse, orworry you: Attempts to commit suicide; acting on

dangerous impulses; acting aggressive orviolent; thoughts about suicide or dying; new or worse depression, anxiety, or panicattacks; feeling agitated, restless, angry orirritable; trouble sleeping; an increase inactivity or talking more than what is normalfor you (mania); other unusual changes inbehavior or mood

2. Serotonin Syndrome: Agitation, hallucinations, coma or other changes in mental status;coordination problems or muscle twitching(overactive reflexes); fast heartbeat, high orlow blood pressure; sweating or fever; nausea,vomiting, or diarrhea; muscle stiffness ortightness.

3. Increased chance of bleeding: VIIBRYD andother antidepressant medicines may increaseyour chance of bleeding or bruising, especiallyif you take the blood thinner warfarin(Coumadin®, Jantoven®), a non-steroidalanti-inflammatory drug (NSAID), or aspirin.

4. Manic episodes: Greatly increased energy;severe trouble sleeping; racing thoughts;reckless behavior; unusually grand ideas;excessive happiness or irritability; talking moreor faster than usual.

5. Discontinuation symptoms: Do not suddenlystop VIIBRYD without first talking to yourhealthcare provider. Stopping VIIBRYDsuddenly may cause serious symptoms including: flu-like symptoms (eg, headache,sweating, nausea); anxiety, high or low mood, irritability, feeling restless or sleepy; dizziness,electric shock-like sensations, tremor, andconfusion. If your healthcare provider decidesthat you should stop taking VIIBRYD, yourhealthcare provider should slowly decrease(taper) your dose.

6. Seizures or convulsions.7. Glaucoma (angle-closure glaucoma): Many

antidepressant medicines including VIIBRYDmay cause a certain type of eye problem calledangle-closure glaucoma. Call your healthcareprovider if you have changes in your vision oreye pain.

8. Low salt (sodium) levels in the blood:Elderly people may be at greater risk forthis. Symptoms may include: headache; weakness or feeling unsteady; confusion, problems concentrating or thinking or memoryproblems.

Who should not take VIIBRYD?• Do not take VIIBRYD if you take a Monoamine

Oxidase Inhibitor (MAOI). Ask your healthcareprovider or pharmacist if you are not sure ifyou take an MAOI, including the antibiotic linezolid

• Do not take an MAOI within 2 weeks of stopping VIIBRYD unless directed to do soby your healthcare provider

• Do not start VIIBRYD if you stopped takingan MAOI in the last 2 weeks unless directed to do so by your healthcare providerPeople who take VIIBRYD close in time totaking an MAOI may have serious or evenlife-threatening side effects. Get medicalhelp right away if you have any of these symptoms: high fever; uncontrolled musclespasms; stiff muscles; rapid changes in heartrate or blood pressure; confusion; or loss ofconsciousness (pass out).

What should I tell my healthcare provider before taking VIIBRYD?Before starting VIIBRYD, tell your healthcare provider if you:• have liver or kidney problems• have or had seizures or convulsions• have bipolar disorder (manic depression)

or mania• have low sodium levels in your blood• have or had bleeding problems• drink alcohol• have any other medical conditions• are pregnant or plan to become pregnant. It is

not known if VIIBRYD will harm your unbornbaby. Talk to your healthcare provider aboutthe benefits and risks of treating depressionduring pregnancy

• are breastfeeding or plan to breastfeed.It is not known if VIIBRYD passes into breastmilk. You and your healthcare provider shoulddecide if you should take VIIBRYD whilebreastfeeding

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

and herbal supplements. VIIBRYD and some medicines may interact with each other, may not work as well, or may cause serious side effects when taken together.Especially tell your healthcare provider if you take:• triptans used to treat migraine headache• medicines used to treat mood, anxiety,

psychotic or thought disorders, includingtricyclics, lithium, selective serotonin reuptakeinhibitors (SSRIs), serotonin-norepinephrinereuptake inhibitors (SNRIs), buspirone,amphetamines, or antipsychotics

• tramadol• over-the-counter supplements such as

tryptophan or St. John’s Wort• NSAIDs, aspirin, or warfarin (Coumadin,

Jantoven)• mephenytoin (Mesantoin)• diureticsYour healthcare provider or pharmacist can tell you if it is safe to take VIIBRYD with your other medicines. Do not start or stop any medicine while taking VIIBRYD without talking to your healthcare provider first.

What should I avoid while taking VIIBRYD?• VIIBRYD can cause sleepiness or may affect

your ability to make decisions, think clearly,or react quickly. You should not drive, operateheavy machinery, or do other dangerousactivities until you know how VIIBRYD affects you

• You should avoid drinking alcohol while taking VIIBRYD. See “What should I tell myhealthcare provider before taking VIIBRYD?”

What are the possible side effects of VIIBRYD?VIIBRYD may cause serious side effects, including:• See “What is the most important information

I should know about VIIBRYD?”Common side effects in people who take VIIBRYD include: diarrhea, nausea or vomiting, and trouble sleeping.Tell your healthcare provider if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of VIIBRYD. For more information, ask your healthcare provider or pharmacist.Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.Keep VIIBRYD and all medicines out of the reach of children.

Need more information?• This page summarizes the most important

information about VIIBRYD. Talk to yourhealthcare provider for more information

• Go to www.viibryd.com or call 1-800-678-1605.Please also see full Prescribing Information atwww.viibryd.com

© 2018 Allergan. All rights reserved.Allergan® and its design are trademarks of Allergan, Inc.VIIBRYD® and its design are registered trademarks of Allergan Sales, LLC. All other trademarks are the property of their respective owners.

Based on PI VBD111728_v2-F-05/18VBD41057_v4 09/18