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 PATIENTS ONLY

You can begin the application process by applying via the OPAF Care Connect Patient Portal. The OPAF team will work with your healthcare professional [HCP] to finish the application process. Please follow the instructions below to begin this process.

See U.S. FULL PRESCRIBING INFORMATION, including BOXED WARNING for
ABILIFY MAINTENA, JYNARQUE, REXULTI, and SAMSCA®(tolvaptan) tablets.

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

OPAF Care Connect Benefits

Patients Can Apply Online

Submit and manage your OPAF application 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 your application and more

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Email patient eConsent and HCP eSignatures for a seamless application process

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View your application online

Find Documents Quickly and Easily

Access relevant your 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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Access eConsent forms for future assistance applications

Get Up-to-Date and Timely Notifications

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

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Get updates regarding your application status and determination results

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Receive notifications when it’s time for annual re-enrollment

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Track the status of product shipments

Prefer to fax in your 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 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) extended release injectable suspension:

Download application for assistance for ABILIFY MAINTENA®(aripiprazole) extended release Injectable suspension

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

Download application for assistance for REXULTI®(brexpiprazole) tablets

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

Download application for assistance for SAMSCA®(tolvaptan) tablets

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

Download application for assistance for JYNARQUE®(tolvaptan) tablets

See U.S. FULL PRESCRIBING INFORMATION, including BOXED WARNING for
ABILIFY MAINTENA, JYNARQUE, REXULTI, and SAMSCA®(tolvaptan) tablets.

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

 

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

 

  • Proof of income
  • Proof of US Address 

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

When you submit an application on behalf of a patient, please include proof of income for all members of the household who file a tax return. Acceptable documentation includes one of the following:

  • Federal Income Tax Return (1040, etc.)
  • W-2 from previous tax year
  • 1099-MISC form
  • Two most recent paystubs
  • Social Security award letter
  • Disability income information
  • Unemployment benefits letter
  • Letter from employer on company letterhead

The application must also include an acceptable proof of a US address. Acceptable documentation includes one of the following:

  • Social Security number
  • State driver’s license or State ID
  • US birth certificate
  • US passport
  • Mortgage statement or rental agreement
  • Two (2) utility bills
  • Foreign passport with US visa
  • I-94 form with photograph
  • US military ID
  • US certificate of naturalization or citizenship
  • Green card
  • Alien registration card

The application must also include insurance denial documentation. Acceptable documentation includes one of the following:

  • Explanation of benefits
  • Insurance statement
  • Prior authorization denial letter

Secure messaging ensures patient privacy because it is a HIPAA-compliant, password-protected electronic messaging platform. You can communicate directly with an OPAF Patient Case Coordinator without having to pick up the phone. Through the platform you can securely send electronic messages with any questions, communications, and documents at your convenience.

Because it is HIPAA-compliant, there is a one-time account activation process. The activation process takes less than 3 minutes. Once your account is active, you can send messages to OPAF immediately.

To setup your OPAF secure message account follow the steps below:

  • Click on the (button or envelope) below to start the process
  • The system will prompt you to enter your email address as a "New to SecureContact"
  • A verification email will be sent to the email address that you entered
  • In your email inbox, you will find a message from "[email protected]"
  • Open this message and click on the link to activate your account
  • Complete the account activation by creating a password
  • Your account is active, and you can securely send a message to OPAF

If you have any questions, please contact OPAF at 1-855-727-6274 8:00 AM - 8:00 PM EST.

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®(tolvaptan) tablets.

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.