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.

NUPLAZIDconnect
PO Box 220305
Charlotte, NC 28222-0305

TEL: 844-737-2223


FAX: 844-737-2224
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

Nuplazid Connect Treatment Form

Nuplazid Fact Sheet

Nuplazid Service Request Form

 

Brand Name Medications Covered

 
  • Nuplazid tablet
 

Generic Name

 
  • pimavanserin tablet
 

Eligibility Requirements   

Insurance Status Must have insurance
Those with Part D Eligible? Yes
Income Not disclosed
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Not specified
   

Application

Obtaining Doctor must start by faxing 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 Not specified
Decision Communicated Patient notified
Decision Timeframe Same Day
   

Medication

Amount/Supply Varies
Sent To Patient's home, unless otherwise noted
Delivery Time Varies
Refill Process Not specified
Limit Not specified
Re-application Varies
   

Additional Information

Resources for HEALTHCARE PROFESSIONALS ONLY.

This program also provides copay assistance.


Updated September 26, 2018