CO-PAY SAVINGS CARD

THE ARISTADA CO-PAY SAVINGS PROGRAM

For Illustration Purposes Only

If you have commercial insurance, you may be able to lower your out-of-pocket cost of treatment with ARISTADA INITIO® (aripiprazole lauroxil) and/or ARISTADA® (aripiprazole lauroxil) through the ARISTADA Co-pay Savings Program.

Your co-pay may be as low as $10 per prescription. Restrictions apply. For more information and to see if you are eligible for this program, please see the terms and conditions.

When enrolling, you will have to answer a few questions to confirm that you meet the program eligibility requirements.

START ENROLLMENT

Thank you for enrolling in the ARISTADA Co-pay Savings Program.

*Required fields.

Please complete the following required field(s):

Because you do not meet the minimum age requirement of 18 years of age, you are not eligible for the ARISTADA Co-pay Savings Program at this time.

I am*

An adult with a prescription of ARISTADA and/or ARISTADA INITIO

The legal guardian or a family member of an adult with a prescription of ARISTADA and/or ARISTADA INITIO

Please provide the following information about the person who has been prescribed ARISTADA:

Contact Information

First Name*

Last Name*

Date of Birth*

Zip Code*

Cell Phone^†Optional

^†By providing my cell phone number, I give Alkermes, the makers of ARISTADA and ARISTADA INITIO, permission to contact me by phone or by text message in the future with information on Alkermes products and services. Message and data rates may apply. You may opt out of receiving communications at any time.

Alkermes will not sell, share, use, or distribute your personal information outside of these terms of agreement. Please click here to read our Privacy Policy.

The following information is required to confirm eligibility.

Please review the terms and conditions before downloading this card.

By checking the box below, I certify that:

I am 18 years or older and have valid prescription for ARISTADA INITIO and/or ARISTADA.
I have commercial insurance and am not enrolled in, or covered by, any local, state, federal or other government program that pays for any portion of medication costs (including but not limited to Medicare or Medicaid, Medigap, VA, DOD, TRICARE or a residential correctional program).
I understand that the information collected will be used to administer the ARISTADA Co-pay Savings Program.

I have read, understand, and agree to comply with the Terms and Conditions of this program.

Thank you for providing the required information.

You can now download your ARISTADA Co-pay Savings Card.

Frequently asked questions

How much will I save?

If you have commercial insurance, Alkermes may be able to help reduce your co-pay to as low as $10 per fill.

Maximum savings per fill is $800.00 for ARISTADA 441 mg, 662 mg, and 882 mg up to 12 fills per calendar year, with maximum savings up to $7600 per calendar year. Maximum savings per fill is $1600.00 for ARISTADA 1064 mg up to 6 fills per calendar year, with maximum savings up to $7600 per calendar year. Minimum out-of-pocket cost per fill, after co-pay savings applied, is $10.

For ARISTADA INITIO, maximum savings is up to $2000.00 total, and Co-pay Savings Card may be used up to 4 times per calendar year.

What happens if I change pharmacies?

Present your Co-pay Savings Card with a valid prescription for ARISTADA INITIO/ARISTADA at the new pharmacy. If your prescription was called into the pharmacy by your doctor, simply present your Co-pay Savings Card to the pharmacist.

Am I eligible for the Co-pay Savings Card?

You must have a valid prescription for ARISTADA and/or ARISTADA INITIO
You must live in the United States or Puerto Rico
You must have commercial insurance
You are not eligible if you are enrolled in, or covered by, any local, state, federal, or other government program that pays for any portion of the medication costs (including but not limited to Medicare or Medicaid, Medigap, VA, DOD, TRICARE, or a residential correctional program)

Can I be reimbursed for the Co-pay Savings Card if I already paid my co-pay?

Eligible patients may receive benefits for valid claims submitted with a date of service that is up to 90 days prior to the initial enrollment date.

Please call our program administrator McKesson at 1-800-657-7613 (8:00 AM‌-8:00 PM ET, Monday-Friday) to request a Direct Member Reimbursement form (DMR), or download the form from patientrebateonline.com.

Can I use my Co-pay Savings Card if I do not have insurance or if my insurance does not cover ARISTADA INITIO or ARISTADA?

No, the ARISTADA Co-pay Savings Card is only approved for patients with commercial insurance. If you would like to learn more about other forms of assistance from Alkermes, please call ARISTADA Care Support at 1-866-ARISTADA or 1-866-274-7823 (9:00 AM-8:00 PM ET, Monday-Friday).

You cannot use the Co-pay Savings Card if you become eligible for any local, state, federal, or other government program that pays for any portion of the medication costs (including but not limited to Medicare or Medicaid, Medigap, VA, DOD, TRICARE, or a residential correctional program).

Can I use the Co-pay Savings Card when I pick up my loved one’s prescription?

Yes, present their Co-pay Savings Card to the pharmacist along with their primary insurance information. If the pharmacist has any questions about using the card, they should call the LoyaltyScript® program for the ARISTADA Co-pay Savings Program at 1-800-657-7613 (8:00 AM‌-8:00 PM ET, Monday-Friday).

Can I use my card with a mail order provider?

There are several prescription mail order service providers available. We have processed transactions from many of them. To determine if your mail order provider will accept an ARISTADA INITIO or ARISTADA Co-pay Savings Card, we recommend that you call them and ask. In order to process the transaction, they will need the numbers on the front of the card, so have the card ready when you call.

Do I need a new prescription to use the Co-pay Savings Card or can I use it for my existing prescription?

No, it is not necessary to obtain a new prescription to use the card as long as you have a valid prescription for ARISTADA INITIO/ARISTADA.

Please note that you must meet the Program requirements every time you use the Co-pay Savings Card.

Is there a charge to use the card?

No, there is no charge to use the card. The benefit is provided to you by Alkermes, Inc. You will need to pay the balance of your co-pay.

Hear from others living with schizophrenia and learn how ARISTADA is working for them.

WATCH VIDEO