Has your physician prescribed the ULTRASE®, ULTRASE® MT or VIOKASE® brand of pancreatic enzyme? If so, your ULTRASE® and ULTRASE® MT Capsule or VIOKASE® Tablet should look like one of the capsules or tablets in the pictures below. If you received a prescription for ULTRASE®, ULTRASE® MT or VIOKASE® and your medicine does not look like one of the capsules or tablets below, your prescription may have been improperly substituted.
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If you believe your ULTRASE®, ULTRASE® MT or VIOKASE® prescription has been improperly substituted, please provide us with the information requested below. There are no therapeutic equivalents to ULTRASE®, ULTRASE® MT or VIOKASE®.
We intend to use this information to contact the pharmacy to discuss the laws relating to pancreatic enzyme substitution to avoid improper substitution. We might also contact the State Board of Pharmacy to discuss the possible improper substitution by the pharmacy. If you agree to allow us to use this information, please mark "yes" below.
Do you agree to allow us to use this information to contact the pharmacy to discuss the possible improper substitution? Do you also agree to allow us to discuss this possible improper substitution with the State Board of Pharmacy?
YES NO