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Assure for Abilify Maintena
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Otsuka
PO Box 220684
Charlotte, NC 28222
Phone
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855-999-2627
Fax:
855-876-2627
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Eligibility
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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
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Doctors or the doctor's office must call for an application to be faxed or it can be downloaded. |
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Required
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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. |
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Supply
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Up to 1 month supply |
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Ship To
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Doctor's office |
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Note
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Resources for HEALTHCARE PROFESSIONALS ONLY. |
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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.
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| Abilify Maintena injection; extended release |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form |
(Requires Acrobat Reader) 
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