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.

If you’re eligible for no-cost medication, talk to your healthcare professional (HCP) and ask them to submit an application. Please note that only your HCP can apply on your behalf.

Having your healthcare professional [HCP] apply online at the OPAF Care Connect website 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):

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 ensure timely processing of your application, please be sure that your healthcare professional [HCP] has all of your required supporting documentation. You’ll also be required to provide eConsent while at your HCP’s office, or by following a link you’ll receive via email. You may also need to provide additional information so your HCP can complete your application.

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, they’ll receive an answer within 48 hours; if the application is faxed to OPAF, your HCP will receive an answer within 5 business days. 

Once the application is submitted, your HCP can track the status of your application and notify you about your results. If you’re accepted for OPAF assistance, your HCP will need to apply on your behalf each year to continue with support. If you aren’t accepted for OPAF assistance, please check your eligibility again when your income or insurance coverage changes.
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).

Eligible patients prescribed Otsuka medications ABILIFY MAINTENA® (aripiprazole), JYNARQUE® (tolvaptan), REXULTI® (brexpiprazole), or SAMSCA® (tolvaptan) may be eligible for coverage assistance beyond OPAF.

The Otsuka America Pharmaceutical website has more information about additional support options. 
 

Whether or not you’re being treated with Otsuka medications, consider exploring the following assistance programs:
RxAssist
NeedyMeds
PPA Rx
MedData

If you’re an HCP interested in streamlining the patient medication assistance process in your practice, visit:

OPAF Care Connect
MD Cares

 

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).

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 residency. Acceptable documentation includes one of the following:

  • Social Security number
  • State driver’s license
  • US birth certificate
  • US passport
  • Foreign passport with US visa
  • I-94 form with photograph
  • US military ID
  • US certificate of naturalization or citizenship

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.