Alkermes® Hospital Inpatient Free Trial Program

Alkermes Inc., ("Alkermes") is offering your patients the opportunity to receive free trial units of Alkermes products to facilitate prompt patient trial of the products in the inpatient hospital and crisis stabilization unit settings of care.

Register for the program
Order and receive your initial free trial unit(s)
Trial an appropriate inpatient in the hospital or crisis stabilization unit
Sign in and initiate a replacement order for dispensed trial unit

The Alkermes Inpatient Free Trial Program is available only to inpatient hospital and crisis stabilization unit pharmacies that are unable to accept PDMA samples and are validly licensed under applicable state law. To receive free trial units for appropriate patients, registration and agreement to program terms and conditions is required.

To participate in the Alkermes Free Trial Program, please begin the registration process by completing the required information below. When providing state license information, please be sure to enter as shown on license (i.e., name as shown and/or state license number). We will process your request as soon as possible.

Asterisks (*) Indicate Mandatory Fields

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In order to participate in the Hospital Inpatient Free Trial Program and receive free trial units on behalf of your inpatients, the following terms and conditions must be accepted. You are required to check all mandatory boxes (noted with an asterisk) indicating you agree, understand and will follow the terms and conditions of the program. Failure to follow the terms and conditions may result in the termination of your ability to receive free trial units for your patients under this program.

Please review the terms and conditions required for the Alkermes Hospital Inpatient Free Trial Program. You must indicate your acceptance of the following program terms and conditions in order to participate in this program.

Terms and Conditions
  1. I hereby request a free trial unit(s) of Alkermes product subject to the terms and conditions above.
  2. I certify that I am a licensed pharmacist eligible to receive and dispense Alkermes product(s).
  3. I certify that the free trial product(s) may be dispensed only with a valid prescription from a provider licensed or authorized under state law to prescribe.
  4. I acknowledge that free trial units are provided through this program by Alkermes for the benefit of patients and certify that they will not be sold, traded, bartered or returned for credit and that I will not separately bill the patient, the patient's insurance or any government healthcare program for such product and that it will be properly reported on any cost report or as otherwise required.
  5. I acknowledge that there is no obligation to continue the use of Alkermes product(s) or to purchase any Alkermes product(s) for any patient receiving free trial product under the Alkermes® Hospital Inpatient Free Trial Program and I will inform participants in this program of this fact.