Otsuka_Patient_Assistance_Foundation_KO_Logo Otsuka_Patient_Assistance_Foundation_KO_Logo ABILIFY MAINTENA® (aripiprazole) JYNARQUE® (tolvaptan) REXULTI® (brexpiprazole) SAMSCA® (tolvaptan) $ R x

THIS SECTION IS FOR HEALTHCARE PROFESSIONALS (HCPs) ONLY

If you’re a patient and would like to apply for coverage, please check your eligibility.

If you qualify, please contact your HCP, who must apply on your behalf. Learn more about the application process.

OPAF Care Connect Benefits

Apply Online For Your Patients

Submit and manage your patient applications from start to finish:

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Receive eligibility determination within 2 business days

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Use your work space to find patient applications, consent forms, and documents

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Email patient eConsent and HCP eSignatures for a seamless application process

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Store individual prescriber information and patient prescription details for quick product orders

Find Documents Quickly and Easily

Access relevant patient documentation and treatment information in a secure, online location:

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Search for patient information quickly with My Case Search

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Initiate annual applications from existing patient case information

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Store patient eConsent forms for future assistance applications

Get Up-to-Date and Timely Notifications

Stay informed with email notifications for patient applications and product requests:

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Get updates regarding your patient application status and determination results

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Receive notifications when it’s time for annual patient reapplications

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Track the status of product shipments

Prefer to fax in an application for your patient? Just follow these 3 simple steps:

  1. Download and print the application
  2. Collect all required documentation from your patient
  3. Fax the application and the documentation to OPAF at 1-844-727-6274

Please note: Faxed applications are processed within 5 business days. If this is a time-sensitive request, please submit an application online

If you are applying for assistance for ABILIFY MAINTENA® (aripiprazole):

Download application for assistance for ABILIFY MAINTENA® (aripiprazole)

If you are applying for assistance for REXULTI® (brexpiprazole):

Download application for assistance for REXULTI® (brexpiprazole)

If you are applying for assistance for SAMSCA®(tolvaptan):

Download application for assistance for SAMSCA®(tolvaptan)

If you are applying for assistance for JYNARQUE®(tolvaptan):

Download application for assistance for JYNARQUE®(tolvaptan)

To help expedite your patient’s application, be sure to include the proper documentation with your fax, including:

  • Proof of income
  • Proof of residency 

Have Any Questions?

See OPAF FAQs

During this extraordinary time, Otsuka Patient Assistance Foundation, Inc. (OPAF) continues to assist patients that have been prescribed an Otsuka medication. Our foundation is open during our standard business hours of Monday-Friday 8am-8pm EDT.

If you are facing a hardship because of the COVID-19 crisis such as:

  • Changes to your employment status such as losing your job or being temporarily furloughed;
  • Changes in your insurance or medication costs;

Please contact OPAF immediately at 1-855-727-6274 to discuss potential assistance.

We are continuing our goal of helping patients that are facing difficulty accessing their prescribed Otsuka medication.

April 2020PAUS20EUC0002

During this extraordinary time, Otsuka Patient Assistance Foundation, Inc. (OPAF) continues to assist patients that have been prescribed an Otsuka medication. Our foundation is open during our standard business hours of Monday-Friday 8am-8pm EDT.

If you are facing a hardship because of the COVID-19 crisis such as:

  • Changes to your employment status such as losing your job or being temporarily furloughed;
  • Changes in your insurance or medication costs;

Please contact OPAF immediately at 1-855-727-6274 to discuss potential assistance.

We are continuing our goal of helping patients that are facing difficulty accessing their prescribed Otsuka medication.

April 2020PAUS20EUC0002

Supported Medications

OPAF provides eligible patients no-cost support for the following prescribed medications:

See U.S. FULL PRESCRIBING INFORMATION, including BOXED WARNING for
ABILIFY MAINTENA, JYNARQUE, REXULTI, and SAMSCA.

See MEDICATION GUIDES for ABILIFY MAINTENA, JYNARQUE, REXULTI, and SAMSCA.

To report SUSPECTED ADVERSE REACTIONS, contact Otsuka America Pharmaceutical, Inc. at
1-800-438-9927 or FDA at 1-800-FDA-1088 (www.fda.gov/medwatch).

Otsuka America Pharmaceutical, Inc. does not control or influence how Otsuka Patient Assistance Foundation, Inc. distributes funds.