Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
 

Nuplazid Connect

For Healthcare Professionals Only

Provided by: Acadia Pharmaceuticals Inc.


TEL: 844-737-2223


FAX: 844-737-2224
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

Nuplazid Connect Treatment Form

Nuplazid Fact Sheet

 

Brand Name Medications Covered

 
  • Nuplazid tablet
 

Generic Name

 
  • pimavanserin tablet
 

Eligibility Requirements   

Insurance Status Must have no insurance or prescription coverage
Those with Part D Eligible? No
Income Not disclosed
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Yes
   

Application

Obtaining Doctor must start byfaxing enrollment form to program
Receiving Downloaded from website
Returning Fax from Doctor's office
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Inform Doctor that he/she is in need
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply Not specified
Sent To Not specified
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
Re-application Not specified
   

Additional Information

Resources for HEALTHCARE PROFESSIONALS ONLY.


Updated July 19, 2017