
Check
eligibility
for
patients
This interactive tool helps patients, caregivers, and healthcare professionals determine no-cost medication eligibility from the Otsuka Patient Assistance Foundation, Inc. (OPAF).
Your information will not be stored.
Please answer all of the following questions:
We've detected that you're currently located outside of the United States/Puerto Rico.
Assistance from the Otsuka Patient Assistance Foundation, Inc. (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.
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.
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.
If you have been prescribed an
- 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
See MEDICATION GUIDES for
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.
If you have been prescribed an
Or, if you prefer, you can download the product specific application below and bring it or email it to your HCP.
See U.S. FULL PRESCRIBING INFORMATION for NUEDEXTA.
See U.S. FULL PRESCRIBING INFORMATION, including BOXED WARNING for
See MEDICATION GUIDES for
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
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.