THIS SECTION IS FOR PATIENTS AND CAREGIVERS ONLY
Patients can download forms/
applications
To help you get started, please view our short video that will walk you through how to apply and what to expect from the process.
Prefer to fax in an application?
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
Please note: Faxed applications are processed within 5 business days. If this is a time-sensitive request, please submit an application online.
(aripiprazole) extended-release injectable suspension
(aripiprazole) extended-release injectable suspension
(brexpiprazole) tablets
(dextromethorphan HBr and quinidine sulfate) capsules
(sibeprenlimab-szsi) injection
(tolvaptan) tablets
See GLOBAL FULL PRESCRIBING INFORMATION for NUEDEXTA and VOYXACT.
See U.S. FULL PRESCRIBING INFORMATION, including BOXED WARNING for
See MEDICATION GUIDES for
Want to apply online?
Use the OPAF Care
Connect Patient Portal.
To help expedite your application, be sure to include the proper documentation with your application submission, including:
- Proof of income
- Proof of residency
Have any questions?
Patients Can Apply Here
Would like to apply online? Utilize the OPAF Care Connect Patient Portal.
Receive eligbility determination within 2 business days
Use your work space to find your application and more
View your application online
Get up-to-date and timely notifications
Stay informed with email notifications for patient applications and product requests:
- Get updates regarding your application status and determination results
- Receive notifications when it’s time for annual
re-enrollment - Track status of product shipments