|
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)
|
|
|