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

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Otsuka Patient Assistance Foundation (OPAF) Patient Assistance Program

This program provides medication at no cost.

Provided by: Otsuka Patient Assistance Foundation, Inc.

PO Box 3640
Gaithersburg, MD 20885-3640

TEL: 855-727-6274


FAX: 844-727-6274
Languages Spoken:

English, Others By Translation Service

Program Website

 

Program Applications and Forms

Otsuka Patient Assistance Foundation (OPAF) Application Form (Abilify Maintena, Rexulti)

Otsuka Patient Assistance Foundation (OPAF) Application Form (Jynarque, Samsca)

 

Medications

  • Abilify Maintena injection; extended release (aripiprazole)
 

Eligibility Requirements   

Insurance Status *Contact program for details.
Those with Part D Eligible? Varies
Income Based on FPL
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? United States or Puerto Rico
   

Application

Obtaining Doctor/Doctor's office must call, download or apply online
Receiving Complete online, download from website or faxed.
Returning Fax, mail or submit online
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach proof of income and residency
Decision Communicated Doctor notified
Decision Timeframe Varies
   

Medication

Amount/Supply Varies
Sent To Doctor's office or patient's home
Delivery Time Not specified
Refill Process Not specified
Limit Varies
Re-application Varies
   

Additional Information


Updated October 12, 2021


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

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HealthWell Foundation Copay Program

This is a copay assistance program

Provided by: HealthWell Foundation


TEL: 800-675-8416


Languages Spoken:

English, Others By Translation Service

Program Website

 

Program Applications and Forms

HealthWell Foundation Copay Program Enrollment: Contact program

HealthWell Foundation COVID-19 Ancillary Costs: Contact program

 

Medications

  • Abilify Maintena injection; extended release (aripiprazole)
 

Eligibility Requirements   

Insurance Status May have insurance
Those with Part D Eligible? Yes
Income Varies
Diagnosis/Medical Criteria FDA Approved Diagnosis - See Program Website for Details
US Residency Required? Must reside in the US
   

Application

Obtaining Call or complete online
Receiving Sent out or may be completed online
Returning Mail
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Patient notified in writing
Decision Timeframe 3-5 business days
   

Medication

Amount/Supply Not applicable
Sent To Varies
Delivery Time Not specified
Refill Process Good for one year
Limit Not specified
Re-application New application every 12 months
   

Additional Information

This program provides financial assistance to eligible individuals to cover coinsurance, copayments, healthcare premiums and deductibles for certain treatments. Also, for those who are eligible for health insurance, but cannot afford the insurance premium, the foundation may be able to help by paying some or all of the medical portion of insurance premiums. The patient is being treated for a specific disease for which funding is available and has insurance that covers the treatment for this disease.

Call for most recent medications as the list is subject to change.

Updated October 25, 2021


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 3 of 3.
 

Abilify Maintena

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Patient Access Network Foundation (PAN)

This is a copay assistance program

Provided by: Patient Access Network Foundation


TEL: 866-316-7263


FAX: 866-316-7261
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Patient Access Network Foundation (PAN) Application: Contact program

 

Medications

  • Abilify Maintena injection; extended release (aripiprazole)
 

Eligibility Requirements   

Insurance Status *See Additional Information section below
Those with Part D Eligible? Determined case by case
Income Between 400-500% of FPL
Diagnosis/Medical Criteria FDA Approved Diagnosis - See Program Website for Details
US Residency Required? Must reside and receive treatment in US
   

Application

Obtaining Call or complete online
Receiving Complete online or by phone
Returning Complete online or by phone
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Call for information or inform doctor that he/she is in need
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe Within 48 hours
   

Medication

Amount/Supply Not applicable
Sent To Patient sent card to be used at pharmacy
Delivery Time Once approved; shipped same day
Refill Process Patient presents voucher/card to pharmacy for each refill
Limit None
Re-application New application every 12 months
   

Additional Information

*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance.

Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly.

Note: All new enrollment is now done electronically or over the phone. Contact program for details.

Updated November 29, 2021