Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 2.
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Aristada Care Support Co-Pay Assistance Program

For Healthcare Professionals Only

Provided by: Alkermes, Inc.


TEL: 866-274-7823


FAX: 844-464-7171
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Aristada Care Support Copay Assistance Enrollment Form

 

Medications

  • aripiprazole lauroxil injection for suspension; extended release (Aristada (441mg)) Injection for Suspension; Extended Release
 

Eligibility Requirements   

Insurance Status Must be commercially insured
Those with Part D Eligible? No, must be ineligible
Income Not applicable
Diagnosis/Medical Criteria Schizophrenia
US Residency Required? Yes
   

Application

Obtaining Download from website
Receiving Faxed or downloaded from website
Returning Fax
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. *see below for details
Sent To Doctor's office or specific site
Delivery Time Not specified
Refill Process Not specified
Limit One year
Re-application New application every 12 months
   

Additional Information

Resources for HEALTHCARE PROFESSIONALS ONLY.
Contact program for details: www.AristadaHCP.com

*Eligible patients may have assistance up to $500 per fill for Aristada 441mg, 662mg, 882mg with a Co-pay as low as $10.00 per fill.
**Eligible patients may have assistance up to $1000 per fill for Aristada 1064mg with a Co-pay as low as $10.00 per fill

Updated August 07, 2018


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 2.
 

Aristada Care Support Patient Assistance Program

For Healthcare Professionals Only

Provided by: Alkermes, Inc.

PO Box 220549
Charlotte, NC 28222-0549

TEL: 866-274-7823


FAX: 844-464-7171
Languages Spoken:

English Spanish

Program Website

 

Program Applications and Forms

Aristada Care Support Patient Assistance Program Enrollment Form

 

Medications

  • aripiprazole lauroxil (Aristada Initio 675mg) 
  • aripiprazole lauroxil injection for suspension; extended release (Aristada (441mg)) Injection for Suspension; Extended Release
 

Eligibility Requirements   

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

Application

Obtaining Download from website
Receiving Faxed or downloaded from website
Returning Fax
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 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.
Contact program for details: www.AristadaHCP.com


Updated August 07, 2018