Samsca Prescription Assistance Programs

Samsca: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Samsca. Review the information to see if you qualify. The applications are available in Adobe PDF format and should be mailed directly to the provider of the patient assistance program.

If you have any questions, please call the telephone number for the program (not PharmacyChecker.com) or go to the program website.

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Otsuka Patient Assistance Foundation (OPAF) Patient Assistance Program

(Program 1 of 2 — Scroll down to see them all )

Provided by: Otsuka Patient Assistance Foundation, Inc.
None
TEL: 855-727-6274
Languages Spoken:
English, Others By Translation Service
Program Website
Medications
  • Samsca tablet (tolvaptan tablet)
Eligibility Requirements
  • Insurance Status *Contact program for details.
  • Those with Part D Elibible? Varies
  • Income Based on FPL
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? Must live in United States or Puerto Rico
Application
  • Obtaining Health care provider must complete online
  • Receiving Complete online or by phone
  • Returning The application must be submitted online by the health care provider
  • Doctor's Action Enroll in program, complete form and obtain patient consent
  • Applicant's Action Inform Doctor that he/she is in need
  • Decision Communicated Doctor notified
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Varies
  • Sent To Varies
  • Delivery Time Not specified
  • Refill Proces Not specified
  • Limit Varies
  • Re-application Varies
Additional Information
None
Updated November 18, 2019

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for prices here.

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Samsca Defined Pharmacy Network

(Program 2 of 2 — Scroll down to see them all )

Provided by: Otsuka America Pharmaceutical, Inc.
PO Box 220684 Charlotte, NC 28222
TEL: 855-242-7787
ALT PHONE: 855-242-7787
FAX: 855-876-2627
Languages Spoken:
English
Program Website
Program Applications and Forms
Medications
  • Samsca tablet (tolvaptan tablet)
Eligibility Requirements
  • Insurance Status *Contact program for details.
  • Those with Part D Elibible? Not specified
  • Income Household income at or below 300% of FPL
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? Must be a US resident and treated by a US licensed healthcare provider
Application
  • Obtaining Hospital contacts program when preparing to discharge a patient.
  • Receiving Faxed, mailed or downloaded from website
  • Returning Fax or E-Prescribe online
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Inform Doctor that he/she is in need
  • Decision Communicated Patient and Doctor are notified
  • Decision Timeframe Same Day
Medication
  • Amount/Supply Varies
  • Sent To Varies
  • Delivery Time Varies
  • Refill Proces Not specified
  • Limit Varies
  • Re-application Not specified
Additional Information
This program is intended for US HEALTHCARE PROFESSIONALS and/or Professionals involved in Healthcare Reimbursement ONLY. *This is a Postdischarge program: For patients continuing treatment when leaving the hospital, through a network of select specialty pharmacies. Contact the program for details or call Christina, the Osuka Hospital Account Manager (412) 389-3114.
Updated November 11, 2019

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for prices here.

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