NUEDEXTA Co-Pay Savings Card

Answer the questions below to find out if you or someone you care for is eligible for the co-pay savings card to save on a 90-day prescription of NUEDEXTA. You’ll also get other helpful information about NUEDEXTA.

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Are you a patient or a caregiver?

Patient

Caregiver

Is the prescription holder 18 or more years of age?

Yes

Does the prescription holder have commercial or private insurance*?

Yes

*Medicare, Medicaid, Medigap, VA, DoD, TRICARE or other state or federally funded health programs (such as medical assistance programs) do not qualify.

Are the prescription holder’s prescriptions paid for in part or in full under any state or federally funded health program, including but not limited to Medicare, Medicaid, Medigap, VA, DoD, or TRICARE?

Yes

Does the prescription holder already have a co-pay savings card?

Yes, and I want to activate it

Please enter the prescription holder's co-pay savings card ID number.

ID Number

Sorry, you are not eligible for a co-pay savings card.

Patients under 18, those without commercial or private insurance, and/or those whose prescriptions are paid for by a state or federally funded program are not eligible for a NUEDEXTA Co-Pay Savings Card.

NUEDEXTA Connect is designed to help appropriately navigate the complexities of coverage for patients prescribed NUEDEXTA. Find treatment support options.

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Select the prescription holder's neurologic condition.

Please complete the following fields so we can send the information you requested:

First Name

Last Name

Email Address

By opting in, I confirm that I am 18 years of age or older and I understand that the information I have provided will be used by Otsuka America Pharmaceutical, Inc. (“Otsuka”) and its contracted third parties to contact me by email, direct mail, and/or SMS text message with relevant information, to include participation in market research opportunities. I may also receive relevant information from Otsuka in the future. I will have the ability to opt out from receiving Otsuka communications at any time by calling 1-833-468-7852 or by following the opt-out instruction within the communications.

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I Agree

INDICATION and IMPORTANT SAFETY INFORMATION for NUEDEXTA^® (dextromethorphan HBr and quinidine sulfate)

INDICATION:

NUEDEXTA is approved for the treatment of Pseudobulbar Affect (PBA).

PBA is a medical condition that causes involuntary, sudden, and frequent episodes of crying and/or laughing in people living with certain neurologic conditions or brain injury. PBA episodes are typically exaggerated or don’t match how the person feels. PBA is distinct and different from other types of emotional changes caused by neurologic disease or injury.

NUEDEXTA is only available by prescription.

IMPORTANT SAFETY INFORMATION:

Before you take NUEDEXTA, tell your doctor:

If you are taking monoamine oxidase inhibitors (MAOIs), quinidine, or quinidine-related drugs. These can interact with NUEDEXTA causing serious side effects. MAOIs cannot be taken within 14 days before or after taking NUEDEXTA.
If you have previously had an allergic reaction to dextromethorphan, quinidine or quinidine-like drugs.
About all medicines, herbal supplements, and vitamins you take as NUEDEXTA and certain other medicines can interact causing side effects.
If you have had heart disease or have a family history of heart rhythm problems. NUEDEXTA may cause serious side effects, including changes in heart rhythm. If you have certain heart problems, NUEDEXTA may not be right for you. Your doctor may test your heart rhythm (heartbeats) before you start NUEDEXTA.
If you have myasthenia gravis.

While taking NUEDEXTA, call your doctor right away:

If you feel faint or lose consciousness.
If you experience lightheadedness, chills, fever, nausea, or vomiting as these may be signs of an allergic reaction to NUEDEXTA. Hepatitis has been seen in patients taking quinidine, an ingredient in NUEDEXTA.
If you have unexplained bleeding or bruising. Quinidine, an ingredient in NUEDEXTA, can cause a reduction in the number of platelets in your blood which can be severe and, if left untreated, can be fatal.
If you feel dizzy, since it may increase your risk of falling.
If you have muscle twitching, confusion, high blood pressure, fever, restlessness, sweating, or shivering, as these may be signs of a potential drug interaction called serotonin syndrome.

IMPORTANT SAFETY INFORMATION: (Continued)

While taking NUEDEXTA, call your doctor right away:

If you feel faint or lose consciousness.
If you experience lightheadedness, chills, fever, nausea, or vomiting as these may be signs of an allergic reaction to NUEDEXTA. Hepatitis has been seen in patients taking quinidine, an ingredient in NUEDEXTA.
If you have unexplained bleeding or bruising. Quinidine, an ingredient in NUEDEXTA, can cause a reduction in the number of platelets in your blood which can be severe and, if left untreated, can be fatal.
If you feel dizzy, since it may increase your risk of falling.
If you have muscle twitching, confusion, high blood pressure, fever, restlessness, sweating, or shivering, as these may be signs of a potential drug interaction called serotonin syndrome.

The most common side effects of NUEDEXTA include: diarrhea, dizziness, cough, vomiting, weakness, and swelling of feet and ankles. This is not a complete list of side effects. Tell your doctor about any side effect that bothers you or does not go away.

You are encouraged to report side effects of NUEDEXTA^® (dextromethorphan HBr and quinidine sulfate). Please contact Otsuka America Pharmaceutical, Inc. at 1-800-438-9927 or FDA at 1-800-FDA-10881-800-FDA-1088 (www.fda.gov/medwatch).

Please read FULL PRESCRIBING INFORMATION.

If you are taking monoamine oxidase inhibitors (MAOIs), quinidine, or quinidine-related drugs. These can interact with NUEDEXTA causing serious side effects. MAOIs cannot be taken within 14 days before or after taking NUEDEXTA.

If you have previously had an allergic reaction to dextromethorphan, quinidine or quinidine-like drugs.
About all medicines, herbal supplements, and vitamins you take as NUEDEXTA and certain other medicines can interact causing side effects.
If you have had heart disease or have a family history of heart rhythm problems. NUEDEXTA may cause serious side effects, including changes in heart rhythm. If you have certain heart problems, NUEDEXTA may not be right for you. Your doctor may test your heart rhythm (heartbeats) before you start NUEDEXTA.

NUEDEXTA Co-Pay Savings Card

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Sorry, you are not eligible for a co-pay savings card.

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INDICATION and IMPORTANT SAFETY INFORMATION for NUEDEXTA® (dextromethorphan HBr and quinidine sulfate)

INDICATION:

IMPORTANT SAFETY INFORMATION:

IMPORTANT SAFETY INFORMATION: (Continued)

While taking NUEDEXTA, call your doctor right away:

IMPORTANT SAFETY INFORMATION:

INDICATION and IMPORTANT SAFETY INFORMATION for NUEDEXTA^® (dextromethorphan HBr and quinidine sulfate)