THIS SECTION IS FOR PATIENTS ONLY
You can begin the application process by applying via the OPAF Care Connect Patient Portal. The OPAF team will work with your healthcare professional [HCP] to finish the application process. Please follow the instructions below to begin this process.
OPAF Care Connect Patient Portal
If you’re a patient, you can use the OPAF Care Connect Patient Portal to submit and track applications, download forms, upload required documents, and more. Plus, the portal offers the fastest patient application processing time — you’ll receive your eligibility determination within 48 hours once all documentation has been submitted. If you do not have access to the portal, you can download the paper application below.
Enrollment Application for
Enrollment Application for
Enrollment Application for REXULTI® (brexpiprazole) tablets
Enrollment Application for NUEDEXTA® (dextromethorphan HBr and quinidine sulfate) capsules
Enrollment Application for SAMSCA® (tolvaptan) tablets
Enrollment Application for JYNARQUE® (tolvaptan) tablets
See U.S. FULL PRESCRIBING INFORMATION for NUEDEXTA.
See U.S. FULL PRESCRIBING INFORMATION, including BOXED WARNING for
See MEDICATION GUIDES for
Patients Can Apply Online
Submit and manage your OPAF application from
start to finish:
Receive eligibility determination
within 2 business days
Use your work space to find your
application and more
View your application online
Find documents
quickly
and easily
Access your relevant documentation and treatment information in a secure, online location:
- Search for patient information quickly with My Case Search
- Initiate annual applications from existing patient case information
- Store patient eConsent forms for future assistance applications
Get up-to-date and
timely notifications
Stay informed with email notifications for patient applications and product requests:
- Get updates regarding your application status and determination results
- Receive notifications when it’s time for annual re-enrollment
- Track status of product shipments
Register today
Prefer to fax in an application for your patient? Just follow these 3 simple steps:
- Download and print the application
- Collect all required documentation from your patient
- Fax the application and the documentation to OPAF at 1-844-727-6274
Please note: Faxed applications are processed within 5 business days. If this is a time-sensitive request, please submit an application online.
Enrollment Application for
Enrollment Application for
Enrollment Application for REXULTI® (brexpiprazole) tablets
Enrollment Application for NUEDEXTA® (dextromethorphan HBr and quinidine sulfate) capsules
Enrollment Application for SAMSCA® (tolvaptan) tablets
Enrollment Application for JYNARQUE® (tolvaptan) tablets
See U.S. FULL PRESCRIBING INFORMATION for NUEDEXTA.
See U.S. FULL PRESCRIBING INFORMATION, including BOXED WARNING for
See MEDICATION GUIDES for
To help expedite your patient’s application, be sure to include the proper documentation with your fax, including:
- Proof of income
- Proof of US Address
