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

Otsuka Patient Assistance Foundation (OPAF) Patient Assistance Program

Provided by: Otsuka Patient Assistance Foundation, Inc.

Otsuka Patient Assistance Foundation, Inc.
PO Box 220248
Charlotte, NC 28222-0248

TEL: 855-727-6274


FAX: 844-727-6274
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

Otsuka Patient Assistance Foundation Enrollment Form

Otsuka Code Reference Guide

Otsuka Code Reference Guide for Bipolar 1 Disorder

 

Brand Name Medications Covered

 
  • Abilify Maintena injection; extended release
  • Rexulti tablet
  • Abilify tablet
  • Samsca tablet
 

Generic Name

 
  • aripiprazole injection; extended release
  • brexpiprazole tablet
  • aripiprazole tablet
  • tolvaptan tablet
 

Eligibility Requirements   

Insurance Status *Contact program for details.
Those with Part D Eligible? Varies
Income Varies
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must reside in the US
   

Application

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

Medication

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

Additional Information


Updated November 01, 2017