Otsuka Patient Experience Liaison Enrollment Form
Otsuka Patient Experience Liaison Enrollment Form
Otsuka is committed to the patients we serve. As a patient who has been prescribed an Otsuka product, you are now eligible for personalized support through Otsuka Patient Support™.
Connect with a Patient Experience Liaison (PEL)
Dedicated professionals who can provide you and your care partner(s) with personal support for
prescribed Otsuka medications, which include:
- ABILIFY MAINTENA® (aripiprazole) for extended release injectable suspension
- ABILIFY ASIMTUFII® (aripiprazole) extended release suspension for injection
- ABILIFY MYCITE® (aripiprazole tablets with sensor)
- REXULTI® (brexpiprazole) tablets
U.S. FULL PRESCRIBING INFORMATION, including BOXED WARNING for ABILIFY MAINTENA, ABILIFY ASIMTUFII, ABILIFY MYCITE, and REXULTI.
See MEDICATION GUIDES for ABILIFY MAINTENA, ABILIFY ASIMTUFII, ABILIFY MYCITE, and REXULTI.
To support you and your care partner(s) during your treatment journey, PELs can help with:
- Support after discharge from a hospital or other times when you change care providers
- Questions about insurance, affordability, and getting your prescription filled at the pharmacy
- Scheduling outpatient appointments, including your next injection (if applicable)
Please complete the following information and a PEL will be in contact with you within 2 business days. Note: once you submit, you will receive an email from DocuSign to complete your enrollment.