HOW TO APPLY

Complete the 3 steps below to apply for ABILIFY® (aripiprazole) Tablets, ABILIFY MAINTENA® (aripiprazole), REXULTI® (brexpiprazole), or SAMSCA® (tolvaptan) medications at no cost.

  1. Check Eligibility

  2. Download & Complete

    Both patients and their doctors must complete their own sections of the enrollment form.

    Download Application

    For health care professionals: Please refer to the ICD-10-CM codes when completing the enrollment form.

  3. Mail or Fax

    Send Application in a Self-Addressed Envelope to:

    Otsuka Patient Assistance Foundation, Inc.
    PO Box 220248
    Charlotte, NC 28222-0248

    OR

    Fax Completed Application to (844) 727-6274

What Happens Next?

The application will be reviewed.

In response to a completed application, patients will receive a letter letting them know if they are qualified to receive no-cost medication from the Otsuka Patient Assistance Foundation, Inc.

Patients must reapply each year.

Patients receiving government issued insurance (Medicare, Medicare Part D, Medicaid) will need to reapply at the end of every calendar year. Other qualified patients not on a government issued insurance program must reapply every 12 months.

Need further assistance?

Patients treated with ABILIFY MAINTENA® (aripiprazole), SAMSCA® (tolvaptan), or REXULTI® (brexpiprazole) may be eligible for other coverage assistance, appointment and refill reminders, and additional patient support offerings.

Otsuka-US.com

Have a question?

Find answers to common questions on our Frequently Asked Questions (FAQs) page.

See Our FAQs

Otsuka Patient Assistance Foundation, Inc. (OPAF) provides the following prescribed medications free of cost:

ABILIFY® (aripiprazole) Tablets

See U.S. FULL PRESCRIBING INFORMATION, including BOXED WARNING and MEDICATION GUIDE

ABILIFY MAINTENA® (aripiprazole) for extended release suspension

See U.S. FULL PRESCRIBING INFORMATION, including BOXED WARNING and MEDICATION GUIDE

REXULTI® (brexpiprazole) tablets

See U.S. FULL PRESCRIBING INFORMATION, including BOXED WARNING and MEDICATION GUIDE

SAMSCA® (tolvaptan)

See U.S. FULL PRESCRIBING INFORMATION, including BOXED WARNING and MEDICATION GUIDE

To report SUSPECTED ADVERSE REACTIONS, contact Otsuka America Pharmaceutical, Inc. at 1-800-438-9927 or FDA at 1-800-FDA-1088 (www.fda.gov/medwatch).

Otsuka America Pharmaceutical, Inc. does not control or influence how Otsuka Patient Assistance Foundation distributes funds.