For patients prescribed ABILIFY MAINTENA® (aripiprazole), there are three choices when it comes to ASSURE program offerings.
Which program offerings best fit my patient’s needs?
The Complete ASSURE Program
Choose this option if your patient may benefit from all or some of the ASSURE support offerings.
ASSURE Local Care Centers (LCCs) Only
Choose this option if your patient may benefit from having more convenient alternate treatment locations and flexible appointment times at ASSURE LCCs.
ASSURE Nurse Navigator (ANN) Only
Choose this option if your patient may benefit from dedicated phone support from an ANN.
Connect With a Dedicated Patient Support Manager (PSM)
As part of ASSURE enrollment, a PSM is available to help review coverage and access options for each of your patients, request benefit verification or reverification, and connect patients to resources to help with continuity of care.
For assistance with enrollment,
please call 1-855-242-7787,
8 AM - 8 PM ET, Monday - Friday.
Choose betweentwo enrollment options:
Both you and your patient will need to fill out different sections of the enrollment form.
It may be easiest to complete the form together, if possible.
Enroll Online Through iAssist Recommended
iAssist is a free online tool designed to streamline therapy-speciﬁc care management. With iAssist, you can:
- Securely enroll your patients in the ASSURE Program online
- Save your information, including a one-time physician and patient eSignature, reducing the time it may take to complete patient forms
- Submit and send ePrescriptions (eRx)
- Complete electronic benefits verifications (eBV) and prior authorizations (ePA)
iAssist This button will direct you to the iAssist homepage. For new users, it will only take a few minutes to register for an iAssist account.
Existing users may already be logged in.
Once registered for iAssist, you can...
- Add staff members to your account
- Add new patients by clicking "Start Submission" on your dashboard
- Search for "ABILIFY MAINTENA" and follow the steps to enroll patients in the ASSURE Program
Download Enrollment Form
Once downloaded, complete the enrollment form with your patient. You can fill the form out in the PDF or by hand. When finished, send the form to ASSURE one of two ways:
For a quicker response, we recommend
you fax the enrollment form to:
Mail the enrollment form to:
Otsuka America Pharmaceutical, Inc.
PO Box 3040
Gaithersburg, MD 20885-3040
Get Ready for Enrollment!
This video will give you the guidance you need to help you successfully enroll your patients in ASSURE.
- Each section of the enrollment form is completed either by you or your patient, so it may be easiest to complete the form together
- To complete the enrollment form you will need to have certain materials on hand, such as your patient‘s insurance information (if applicable) and medical history