Enroll your eligible patient to get services like benefit investigation and assistance that may be able to help patients afford ARISTADA. To enroll:
- Download the Enrollment Form, type in your information on screen, print and sign.
- Provide the printed form to your patient or their authorized designee to complete the remaining sections and sign.
- Fax form to ARISTADA Care Support at 1-844-464-7171.
Enroll your patient in any care setting.
Download Form
Sample benefits verification report
The benefits verification report will detail the coverage information for your patients so you can understand their insurance situation.
It will include both pharmacy and major medical benefits, such as co-pays, deductibles, and out-of-pocket maximum amounts.
Download How to Read Summary of Benefits Verification Report Guide
ARISTADA is covered by majority of healthcare plans, including Medicare, Medicaid, Veterans Health Administration,* and most commercial plans. See if your patients are covered.1,2
*In accordance with VA Criteria for Use for Long-acting Injectables.3
References: 1. Data on file. Alkermes, Inc. 2. Pharmacy benefits management services. US Department of Veterans Affairs. Updated May 2024. Accessed May 6, 2024. https://www.pbm.va.gov/nationalformulary.asp 3. VA formulary advisor. US Department of Veterans Affairs. Updated May 2024. Accessed May 6, 2024. https://www.va.gov/formularyadvisor/
The ARISTADA Provider Network provides access to those in search of a healthcare provider to administer ARISTADA INITIO and ARISTADA to appropriate patients and/or provide medical management for patients with schizophrenia, including treatment with ARISTADA.
If you would like to join the Provider Network to ensure your practice is listed, sign up today.
During the initial benefit investigation process, determine whether the payer requires a PA for ARISTADA INITIO or ARISTADA and what the criteria are for PA approval.
- If a PA is required, ask whether the plan has a product-specific PA form and where it can be obtained
- Ask whether a PA can be submitted electronically. If it can, you can use CoverMyMeds to submit the completed prior authorization
- Obtain the telephone number or fax number of the PA department
- Ask the contact to explain the PA process and whether it requires any special forms or a Checklist for Letter of Medical Necessity & Appeal Letter
- Inquire how long the process will take once the necessary forms and documentation are submitted
- If the time for obtaining ARISTADA INITIO and ARISTADA is urgent, ask whether there are procedures for expediting the request on behalf of the patient
This checklist may help facilitate communications with health insurance companies to support patient access to an Alkermes medication.
Download Checklist for Medical Necessity & Appeal Letter
CoverMyMeds offers free prior authorization services and the ability to:
- Find, complete, and submit prior authorization requests for all plans
- Receive electronic determinations, often in real time
- Automatically renew previously submitted prior authorization requests
CoverMyMeds is a third-party platform not created by Alkermes.
Have you had a claim for ARISTADA INITIO and/or ARISTADA denied? You may want to review this checklist and consider submitting an appeal.
- Review the Explanation of Benefits (EOB) to determine the reason for the claim denial
- If additional information is requested, submit it immediately or within the required time frame for processing
- If the denial was due to a technical error, amend it and submit a corrected claim
- Verify the appeals process with the payer:
- Does the payer require use of a specific form?
- Can the appeal be conducted over the telephone?
- If the appeal must be submitted in writing, to whom should it be directed?
- What information must be included with the appeal (eg, a copy of the original claim, EOB, Letter of Medical Necessity [LOMN], or other documentation)?
- How long does the appeals process usually take?
- How will the payer communicate the appeals decision?
- Review the appeal request for accuracy and completeness, including patient identification numbers, coding, and additional information requested
- Consider requesting that the payer have a psychiatrist or other designated provider who is familiar with treating patients with ARISTADA INITIO and/or ARISTADA review the appeal
- File the appeal as soon as possible and within filing time limits
- Reconcile responses to the appeal promptly and thoroughly to ensure an appeal has been processed appropriately
- Record appeals result (eg, payment amount or if further action is required)
This brochure provides a summary of the process for appeals of both Original Medicare and Part D coverage decisions and available sources of information.
Download Medicare Appeals and Exceptions Process Brochure
ARISTADA INITIO and ARISTADA each have their own J-Code. See the list of billing codes and additional information in this compact guide.
Download Guide
ARISTADA INITIO and ARISTADA are available from a variety of pharmaceutical wholesalers. See the comprehensive list here.
Samples are available for your patients with schizophrenia. Request a visit from an ARISTADA representative.
Eligibility Criteria
- Product requested through this Program (Program Product) may only be used in an inpatient hospital or crisis stabilization unit validly licensed (Participating Hospitals).
- This Program is only available for Participating Hospitals that do not accept PDMA-compliant drug samples.
- Program Product may be dispensed only with a valid prescription from a provider licensed or authorized under state law to prescribe the product requested.
- Program Product may only be used for the treatment of medically appropriate adults as recommended by the FDA-approved prescribing information and only if the prescriber has independently determined that the product is clinically appropriate for the patient.
- There is no obligation to continue the use of Alkermes product(s) or to purchase any Alkermes product(s) for any patient receiving Program Product, and all participants in the Program will be informed of this fact.
Program Limits
- There is a maximum limit of 2 free trial units per product per patient per calendar year. Additional limits may apply.
Termination and Exclusion
- Alkermes reserves the right to terminate the Program at any time and will provide notice of any such termination as early as possible. To receive free trial units for your patients, you must agree to all program rules, which can be found at alkermeshospitalprogram.com. For full eligibility terms and restrictions, see the inpatient programs page.
A comprehensive review of product information to assist hospital pharmacists, physicians, and executives in making formulary decisions.
Download Information
Complete the information on this ARISTADA transition form and attach to your patients’ discharge plan for their next place of care. It may help provide important information to their outpatient healthcare professional.
Download Form
Informative brochure about treating schizophrenia with ARISTADA INITIO and ARISTADA.
Download Brochure
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