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

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

 

Patient Assistance Applications

Aristada Care Support Patient Assistance Program Enrollment Form

 

Brand Name Medications Covered

 
  • Aristada (1064mg) injection for suspension; extended release
  • Aristada (882mg) injection for suspension; extended release
  • Aristada (441mg) injection for suspension; extended release
  • Aristada Initio 675mg
  • Aristada (662mg) injection for suspension; extended release
 

Generic Name

 
  • aripiprazole lauroxil
  • aripiprazole lauroxil 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 Call or download
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 Varies
   

Medication

Amount/Supply Varies
Sent To Licensed Health Care Provider
Delivery Time Varies
Refill Process Good for one year
Limit Varies
Re-application New enrollment every 12 months
   

Additional Information

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

This program also provides copay assistance.

Updated September 28, 2018