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

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

Assistance from the Otsuka Patient Assistance Foundation (OPAF) is available only to residents of the US/Puerto Rico.

If you're in the US/Puerto Rico, or are checking on behalf of a resident of the US/Puerto Rico, you can start the eligibility verification process.

Select the medication

Select the type of insurance coverage

Will insurance cover this medication?

Next

To check eligibility for JYNARQUE, please call 1-855-727-6274.

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.

Please speak with your healthcare professional about getting a prescription for one of the OPAF-eligible medications.

We encourage you to call our Dedicated Patient Case Coordinators to discuss your eligibility. They can be reached at 1-855-727-6274, Monday-Friday, AM-8 PM (ET).

You may not be eligible for assistance

We're sorry, but only the medications listed on this site are eligible for financial assistance. This interactive tool is just your first step in determining eligibility for medication from Otsuka provided at no cost.

We encourage you to call our Dedicated Patient Case Coordinators to discuss your eligibility. They can be reached at 1-855-727-6274, Monday-Friday, AM-8 PM (ET).

We invite you to learn more about alternative programs that may provide support. OPAF is not affiliated with any of these programs and does not know their eligibility requirements.

You may not be eligible for assistance

Because insurance coverage already exists for the prescribed medication, financial assistance may not be available. This interactive tool is just your first step in determining eligibility for medication from Otsuka provided at no cost.

We encourage you to call our Dedicated Patient Case Coordinators to discuss your eligibility. They can be reached at 1-855-727-6274, Monday-Friday, AM-8 PM (ET).

We invite you to learn more about alternative programs that may provide support. OPAF is not affiliated with any of these programs and does not know their eligibility requirements.

You may not be eligible for assistance

Based on the household income you entered, financial assistance may not be available. This interactive tool is just your first step in determining eligibility for medication from Otsuka provided at no cost.

We encourage you to call our Dedicated Patient Case Coordinators to discuss your eligibility. They can be reached at 1-855-727-6274, Monday-Friday, AM-8 PM (ET).

We invite you to learn more about alternative programs that may provide support. OPAF is not affiliated with any of these programs and does not know their eligibility requirements.

You may be eligible for assistance

Based on the answers you provided, you may be eligible for coverage.

Here are the next steps:

Talk with your healthcare professional (HCP) and ask them to complete an OPAF online application for you. If you'd prefer, you can download the application and email it to your HCP or bring it to your next appointment.

To help expedite the application process, please be sure to provide your HCP the required documentation.

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

The results of this interactive tool are not a guarantee that you will be approved for assistance. Additional information regarding insurance coverage and income may be needed during the application process before OPAF approval.

You may be eligible for assistance

Based on the answers you provided, you may be eligible for coverage.

Here are the next steps:

Talk with your healthcare professional (HCP) and ask them to complete an OPAF online application for you. If you'd prefer, you can download the application and email it to your HCP or bring it to your next appointment.

To help expedite the application process, please be sure to provide your HCP the required documentation.

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

You've selected that you're unsure if the insurance provider covers the medication. Please check with the insurance provider to confirm medication coverage. Note: If the insurance provider covers the medication, OPAF assistance may not be available. The results of this interactive tool are not a guarantee that you will be approved for assistance. Additional information regarding insurance coverage and income may be needed during the application process before OPAF approval.

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.

If you have been prescribed an Otsuka medication 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.

Having your healthcare professional [HCP] apply online at the OPAF Care Connect Prescriber Portal is the fastest way to get an official decision from OPAF.

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

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 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).

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).

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.

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).

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.

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.