Tools and resources for

ABILIFY ASIMTUFII®
(aripiprazole)

For Patients: In order to redeem this offer you must have a valid prescription for ABILIFY ASIMTUFII^® (aripiprazole) and commercial insurance. This offer may not be redeemed for cash. By using this offer, you are certifying that you meet the eligibility criteria (not a member of a federal, state, or government insurance program) and will comply with the terms and conditions described in the Restrictions section below. Patients with questions about the offer should call 833-742-0816. Patients may pay as little as $5 per fill with an annual maximum benefit of $8,000 and monthly maximum benefit of wholesale acquisition cost plus usual and customary pharmacy charges. Presumes only 1 prescription filled per two calendar months.

Pharmacist: When you use this card, you are certifying that you have not submitted and will not submit a claim for reimbursement under any federal, state, or other governmental programs for this prescription. As a condition of payment, you certify that you are in compliance with all program rules, terms, and conditions, as well as with any obligations to provide notice of your participation in this program to third-party payers as required by law, contract, or otherwise.

Pharmacist Instructions for a Patient with an Eligible Third Party: Submit the claim to the primary Third-Party Payer first, then submit the balance due to PDMI as a Secondary Payer coordination of benefits with patient responsibility amount and a valid Other Coverage Code (e.g., 8). For ABILIFY ASIMTUFII prescription, patient may pay as little as $5 per fill with an annual maximum benefit of $8,000 and monthly maximum benefit of wholesale acquisition cost plus usual and customary pharmacy charges; limits apply. Reimbursement will be received from PDMI.

Valid Other Coverage Code Required. For any questions regarding PDMI online processing, please call the Help Desk at 833-742-0816. 

For Healthcare Professionals: When you apply for this offer, you are certifying that you have not submitted a claim for reimbursement under any federal, state, or other governmental programs for this prescription. Participation in this program must comply with all applicable laws and regulations as a pharmacy provider. By participating in this program, you are certifying that you will comply with the terms and conditions described in the Restrictions section below.

Restrictions: This offer is only valid in the United States and Puerto Rico, and is not transferable. Patients are not eligible if they are under 18 years of age, or are covered in whole or in part by any state program or federal healthcare program, including, but not limited to, Medicare or Medicaid (including Medicaid managed care), Medigap, VA, DOD, or TRICARE. Offer void where prohibited by law, taxed, or restricted. Other restrictions may apply. This program is not health insurance. Otsuka America Pharmaceutical, Inc. has the right to rescind, revoke, or amend this program at any time without notice. Your participation in this program confirms that this offer is consistent with your insurance coverage and that you will report the value received if required by your insurance provider. When you use this card, you are certifying that you understand and will comply with the program rules, terms, and conditions. Program managed by TrialCard on behalf of Otsuka America Pharmaceutical, Inc.