Apply to Otsuka Patient Assistance Foundation
Free Otsuka medicines for eligible uninsured and underinsured patients. Apply directly with the program; here is what it asks and what happens next.
Who can apply?
Limit not published; call 1-855-727-6274. Proof of household gross income required; program may also estimate income by soft credit check.
Limit not published; call 1-855-727-6274. Proof of household gross income required; program may also estimate income by soft credit check.
Serves uninsured and underinsured patients; a Patient Access Advocate does an eligibility analysis. Rules by insurance type are not published on the pages read.
Then what?
Sign
- patient authorization for use and disclosure of health information (includes income estimate by credit information)
- communication consent
Attach
- proof of household gross income for each earner (tax return, W-2, provider income attestation letter, disability income information, etc.)
- proof of US address
- power of attorney if a legal representative signs
Your prescriber
- completes prescriber sections including a signed prescription
Send
- Fax 1-844-727-6274
- Mail to Otsuka Patient Assistance Foundation, Inc., PO Box 4530, Chesterfield, MO 63006
Rather apply online? Apply on the Otsuka Patient Assistance Foundation site.
Questions: call Otsuka Patient Assistance Foundation at 1-855-727-6274. Consent lasts one year; reapply annually (portal sends reapply reminders)..
Free. EveryCard Rx isn't paid by the program and never sends anything for you. Form , rules checked 2026-11-06 from the program's own pages. Something out of date? Tell us.