Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
 
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Aristada Care Support Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Alkermes, Inc.

Alkermes, Inc.
852 Winter Street
Waltham, MA 02451

TEL: 866-274-7823


FAX: 844-464-7171
Languages Spoken:

English Spanish

Program Website

 

Patient Assistance Applications

Aristada Care Support Patient Assistance Program Enrollment Form

 

Brand Name Medications Covered

 
  • Aristada 441mg injection for suspension; extended release
  • Aristada 882mg injection for suspension; extended release
  • Aristada 662mg injection for suspension; extended release
  • Aristada injection for suspension; extended release 441mg,662mg,882mg
 

Generic Name

 
  • aripiprazole lauroxil injection for suspension; extended release
  • aripiprazole lauroxil injection for suspension; extended release 441mg,662mg,882mg
 

Eligibility Requirements   

Insurance Status Must be uninsured
Those with Part D Eligible? No
Income Varies
Diagnosis/Medical Criteria Schizophrenia
US Residency Required? Yes
   

Application

Obtaining Call or download from Programs website
Receiving Faxed or downloaded from website
Returning Fax
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section and sign
Decision Communicated Patient and Doctor are notified
Decision Timeframe Not specified
   

Medication

Amount/Supply 1 monthly treatment
Sent To Licensed Health Care Provider
Delivery Time Varies
Refill Process Good for one year
Limit Varies
Re-application Varies
   

Additional Information

Resources for HEALTHCARE PROFESSIONALS ONLY.

INDICATION: Aristada is indicated for the treatment of schizophrenia.
Aristada is not approved for the treatment of patients with dementia-related psychosis.

This program also provides copay assistance.


Updated July 06, 2017