REXULTI

Indicated For

Major depressive disorder (adjunctive), Schizophrenia, Agitation associated with Alzheimer's dementia

About This Medication

# Otsuka Patient Assistance Foundation (OPAF) Patient Guide: How to Get REXULTI at Low or No Cost ## About REXULTI REXULTI (brexpiprazole) is a prescription medication manufactured by Otsuka America Pharmaceutical, Inc. If you have been prescribed REXULTI but are concerned about the cost, the Otsuka Patient Assistance Foundation (OPAF) may be able to help you access this medication at no cost. ## Who Qualifies for OPAF Assistance OPAF provides no-cost medication support for patients who are **uninsured or underinsured**. The program is designed to help patients who face financial barriers to accessing their prescribed medications. While specific income thresholds are not publicly disclosed, eligibility is determined based on your financial need and current insurance status. You may be eligible if you: - Are uninsured - Have insurance that does not cover REXULTI - Cannot afford your medication due to high out-of-pocket costs - Are a U.S. resident with a valid home address ## Income Eligibility OPAF does not publish specific income limits for program eligibility. Instead, the program evaluates each patient's financial situation individually. During the application process, you will need to provide proof of your household income. The program considers your total household income and the number of people in your household when determining eligibility. If you have no income, you can enter zero on your application—having no income does not disqualify you from assistance. ## Insurance Requirements OPAF is specifically designed for patients who are **uninsured or underinsured**. If you have insurance that denies coverage for REXULTI, you will need to provide documentation of this denial, such as: - Explanation of benefits - Insurance statement - Prior authorization denial letter If you are insured, OPAF may still be able to help if your insurance does not cover REXULTI or if you cannot afford your copayment or coinsurance. ## How to Apply for OPAF Assistance ### Step 1: Gather Required Documentation Before starting your application, collect the following documents: **Proof of Income** (choose ONE): - Federal Income Tax Return (Form 1040 or similar) - W-2 from previous tax year - 1099-MISC form - Two most recent paystubs - Social Security award letter - Disability income information - Unemployment benefits letter - Letter from employer on company letterhead **Proof of Residency** (choose ONE): - Mortgage statement or rental agreement - Two utility bills - State driver's license or State ID with current home address - U.S. address attestation letter from your healthcare provider **Insurance Documentation** (if applicable): - Insurance denial letter or explanation of benefits - Prior authorization denial documentation ### Step 2: Complete Your Application You have three options for submitting your application: **Option 1: Apply Online (Fastest)** - Visit www.otsukapatientassistance.com - Access the OPAF Care Connect portal - Complete your application with all required documentation - Processing time: Up to 48 hours **Option 2: Apply by Fax** - Download the application form from www.otsukapatientassistance.com/patient-forms - Complete all sections accurately - Fax to: 1-844-727-6274 - Processing time: Up to 5 business days **Option 3: Apply by Mail** - Download and complete the application form - Mail to: Otsuka Patient Assistance Foundation, Inc. PO Box 4530 Chesterfield, MO 63006 - Processing time: Up to 5 business days ### Step 3: What to Include in Your Application Make sure your application includes: - Completed patient information section with your name, address, date of birth, and contact information - Patient authorization signature (page 2 of the form) - Insurance information (if you have coverage) - Proof of household income for all contributing household members - Proof of U.S. residency - Insurance denial documentation (if applicable) - Your healthcare provider's information **Important:** Incomplete applications will experience significant delays. Double-check that all sections are filled out completely and all required documents are included. ### Step 4: Work With Your Healthcare Provider While you can apply directly, the fastest way to apply is to work with your healthcare provider. Your doctor or their office staff can: - Help guide you through the application process - Ensure you're providing correct information - Submit the application on your behalf through the OPAF Care Connect portal - Provide an attestation letter for proof of residency if needed Your healthcare provider can contact OPAF at 1-855-727-6274 (Monday-Friday, 8 AM-8 PM ET) if they have questions about the application. ## Application Timeline and Delivery **Processing Time:** - Online applications: Up to 48 hours - Fax or mail applications: Up to 5 business days - In most cases, completed applications are processed within 2 business days **What Happens Next:** Once OPAF receives your complete application, the team will review it for completeness. If additional information is needed, they will contact your healthcare provider. After approval, you will receive a notice in the mail with your eligibility determination. If approved, you will receive your REXULTI medication at no cost. ## What If Your Application Is Denied If your application is denied, you have options: - Contact OPAF at 1-855-727-6274 to understand the reason for denial - Ask if you can reapply with additional documentation - Discuss alternative assistance programs with your healthcare provider - Explore other patient assistance programs or pharmaceutical discount programs ## Need Help? If you have questions about your application or need assistance, contact: - **Phone:** 1-855-727-6274 (Monday-Friday, 8 AM-8 PM ET) - **Website:** www.otsukapatientassistance.com - **Fax:** 1-844-727-6274 All information you submit is kept confidential and protected under HIPAA regulations. ## Important Disclaimer This guide provides general information about the Otsuka Patient Assistance Foundation program. Eligibility requirements, application procedures, and program details are subject to change. For the most current and accurate information, visit www.otsukapatientassistance.com or contact OPAF directly. This program is administered by the Otsuka Patient Assistance Foundation, Inc., which is independent of Otsuka America Pharmaceutical, Inc. Always consult with your healthcare provider about your medication needs and treatment options.

Program information last verified: March 30, 2026