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PRABILIFY MAINTENA®
PATIENT ASSISTANCE PROGRAM


THE SAME CARD FOR ALL ABILIFY MAINTENA PATIENTS

Get a FREE Payment Card for Your ABILIFY MAINTENA Patients


INFORMATION ABOUT THE PROGRAM AND FAQS:

Otsuka Canada Pharmaceutical Inc. and Lundbeck Canada Inc. are pleased to offer
financial support for
patients prescribed ABILIFY MAINTENA (aripiprazole for prolonged release
injectable suspension).

The multi-use program will automatically cover a portion of the prescription
cost.* The Certificate numbers provided on the downloadable card, can be used
for all ABILIFY MAINTENA patients. No cards are required. Limit of one
certificate per patient.

* Based on reasonable mark-up and customary pharmacy fee.

You can use the same certificate number for all patients. If you have any
questions regarding claims processing,
please call the ClaimSecure HelpDesk at 1-800-461-6579.

Payment and processing information for the ABILIFY MAINTENA program

 * The payment for the claims should be processed through ClaimSecure in the
   following manner:
 * Select ClaimSecure as the “Third Party Payer”
 * Enter the Certificate number (10 digits) as it appears above, then enter the
   Group number 37384
 * Select Cardholder as the Relationship Code
 * No expiry date required

If your patient has an electronic drug plan (either public or private), please
enter Abilify Maintena program information as the SECONDARY plan. Send the claim
to your patient’s regular drug plan first and then co-ordinate the claim with
ClaimSecure for a portion of the difference.

If your patient does not have drug coverage or a pay direct plan, please contact
the PANORAMA® Patient Support Program at 1-844-788-8041.
Coverage may vary based on patient plan. Limit one program certificate per
patient. Program valid only in Canada. Program may change or expire at any time
without notice.

All trademarks identified by a ® or a TM are protected trademarks (registered or
unregistered) of their owners or licensors. For more information, please visit
www.otsukacanadatm-mc.ca.
© Otsuka Canada Pharmaceutical Inc. and Lundbeck Canada Inc. All rights
reserved.
OTS-AM-00112E