Check eligibility | Otsuka Patient Assistance Foundation

See U.S. FULL PRESCRIBING INFORMATION for NUEDEXTA.
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.

What happens after I get my eligibility results?

If you have been prescribed NUEDEXTA®(dextromethorphan HBr and quinidine sulfate) capsules and meet the eligible criteria, you may download the paper application and have your healthcare professional submit the form via fax, secure message, or mail.

Assistance for NUEDEXTA® (dextromethorphan HBr and quinidine sulfate) capsules:

Download

If you have been prescribed an ABILIFY MAINTENA®(aripiprazole), REXULTI®(brexpiprazole), SAMSCA®(tolvaptan), or JYNARQUE®(tolvaptan) and meet the eligible criteria, there are several options for applying for patient assistance:

You may talk to your healthcare professional (HCP) and ask them to submit an application on your behalf via the OPAF Care Connect Prescriber Portal.

OR

You may start the patient portion of the OPAF application via the OPAF Care Connect Patient Portal. Once you have submitted your information on the portal, the OPAF team will contact your healthcare professional for additional information, prior to the application assessment.

OR

You may download the paper application and have your healthcare professional submit the form via fax, secure messaging, or mail.

See U.S. FULL PRESCRIBING INFORMATION for NUEDEXTA.

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.

What’s the fastest way for my healthcare professional to apply on my behalf?

If you have been prescribed NUEDEXTA®(dextromethorphan HBr and quinidine sulfate) capsules, the fastest way to apply to OPAF is to download the paper application below and have your healthcare professional submit the form and supporting documentation via fax, secure messaging, or mail.

Assistance for NUEDEXTA® (dextromethorphan HBr and quinidine sulfate) capsules:

Download

If you have been prescribed an ABILIFY MAINTENA®(aripiprazole), REXULTI®(brexpiprazole), SAMSCA®(tolvaptan), or JYNARQUE®(tolvaptan), the fastest way to apply for assistance is to have your healthcare professional HCP apply online at the OPAF Care Connect Prescriber Portal.

Or, if you prefer, you can download the product specific application below and bring it or email it to your HCP.

Assistance for ABILIFY MAINTENA®(aripiprazole) extended release injectable suspension:

Download

Assistance for REXULTI®(brexpiprazole) tablets:

Download

Assistance for SAMSCA®(tolvaptan) tablets:

Download

Assistance for JYNARQUE®(tolvaptan) tablets:

Download

See U.S. FULL PRESCRIBING INFORMATION for NUEDEXTA.
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.

What will my healthcare professional need to submit my application?

To help ensure timely processing of your application, please be sure that your healthcare professional [HCP] has all of your required supporting documentation. This includes patient consent, income documentation, and US address documentation.

If you have any questions, please call our Dedicated Patient Case Coordinators. They can be reached at 1-855-727-6274, Monday-Friday, 8 AM-8 PM (ET).

What happens after my healthcare professional submits my application?

If your healthcare professional [HCP] submits an application online via the OPAF Care Connect Prescriber Portal, they will receive an answer within 48 hours upon receipt of the submitted application and all required supporting documentation.

OR

If the application is faxed/secure messaged/mailed to OPAF, your HCP will receive an answer within 5 business days upon receipt of the application and all required supporting documentation.

If you have any questions, please call our Dedicated Patient Case Coordinators. They can be reached at 1-855-727-6274, Monday-Friday, 8 AM-8 PM (ET).

What if I need further assistance paying for my medication?

Patients prescribed the Otsuka medications ABILIFY MAINTENA®(aripiprazole) extended release injectable suspension, JYNARQUE®(tolvaptan) tablets, REXULTI®(brexpiprazole) tablets, or SAMSCA®(tolvaptan) tablets may receive their medication at no cost if they meet OPAF’s eligibility criteria. If additional assistance is needed for additional barriers, please contact the OPAF Resource and Solutions Center at 1-855-727-6274, Monday-Friday, 8 AM-8 PM (ET). The OPAF Resource and Solution Center will assist the patient in finding other non-affiliated resources that may be able to help.

What if my question isn’t listed here?

Please visit our FAQ section to see a more comprehensive list of questions and answers. If, after reviewing the FAQs, you have any questions, please call our Dedicated Patient Case Coordinators. They can be reached at 1-855-727-6274, Monday-Friday, 8 AM-8 PM (ET).

What happens if I do not meet the eligibility criteria?

Because every patient situation is unique, please call our Dedicated Patient Case Coordinators to discuss your specific situation. They can be reached at 1-855-727-6274, Monday-Friday, 8 AM-8 PM (ET).

If you have any questions about OPAF, eligibility, or the documentation that's required, please visit our FAQ section.

Supported Medications

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

See U.S. FULL PRESCRIBING INFORMATION for NUEDEXTA.
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.

Secure messaging ensures patient privacy because it is a HIPAA-compliant, password-protected electronic messaging platform. You can communicate directly with an OPAF Patient Access Advocate 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 ET.

MESSAGE US

message

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

Check
eligibility
for
patients

Please answer all of the following questions:

We've detected that you're currently located outside of the United States/Puerto Rico.

Medication

Insurance

Household

Income

You may not be eligible for assistance

Before assistance can be considered, a valid prescription is required.

You may not be eligible for assistance

We're sorry, but only the medications listed on this site are eligible for financial assistance.

You may not be eligible for assistance

Because insurance coverage already exists for the prescribed medication, financial assistance may not be available.

You may not be eligible for assistance

Before assistance can be considered, a valid prescription is required.
This interactive tool is just your first step in determining eligibility for medication from Otsuka provided at no cost.

You may be eligible for assistance

Here are the next steps:

You may be eligible for assistance

Here are the next steps:

Supported Medications

Check eligibility for patients

Please answer all of the following questions:

We've detected that you're currently located outside of the United States/Puerto Rico.

Medication

Insurance

Household

Income

You may not be eligible for assistance

Before assistance can be considered, a valid prescription is required.

You may not be eligible for assistance

We're sorry, but only the medications listed on this site are eligible for financial assistance.

You may not be eligible for assistance

Because insurance coverage already exists for the prescribed medication, financial assistance may not be available.

You may not be eligible for assistance

Before assistance can be considered, a valid prescription is required. This interactive tool is just your first step in determining eligibility for medication from Otsuka provided at no cost.

You may be eligible for assistance

Here are the next steps:

You may be eligible for assistance

Here are the next steps:

Supported Medications

Secure Messaging

Welcome to the Otsuka Patient Assistance Foundation, Inc.

Check
eligibility
for
patients

Before assistance can be considered, a valid prescription is required.
This interactive tool is just your first step in determining eligibility for medication from Otsuka provided at no cost.