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Patient Assistance Information

 
1 Program for Abilify Maintena injection; extended release
 
 
Assure for Abilify Maintena

Otsuka
PO Box 220684
Charlotte, NC 28222
Phone : 855-999-2627
Fax: 855-876-2627
Eligibility
> This program is for Healthcare Professionals Only. Patients must be uninsured or underinsured with no prescription coverage. Patients must be at or below 300% of the federal poverty level. Diagnosis and residency requirements have not been disclosed.
Who Can Apply
> Doctors or the doctor's office must call for an application to be faxed or it can be downloaded.
Required
> Patients must inform their doctor that they are in need. Doctors must enroll in the program, complete the application form and obtain the patients consent.
Supply
> Up to 1 month supply
Ship To
> Doctor's office
Note
> Resources for HEALTHCARE PROFESSIONALS ONLY.
 
Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
 
Abilify Maintena injection; extended release
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader