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ENROLLMENT / EXCLUSION FORM To Implement Sections 16-28-40 through 16-28-45, Code of Alabama, 1975 Follow instructions on the back of this form.

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Manufacturer Drug Discount Offering Discount Expiration Web URL Otsuka America Pharmaceutical, Inc. Abilify Savings card Pay as little as $5 a month for brand-nameARISTADA. *Administer 1 injection of ARISTADA INITIO and a single 30 mg dose of oral aripiprazole with the first ARISTADA injection 5. If not starting with ARISTADA INITIO, administer oral aripiprazole for 21 consecutive days with the first ARISTADA injection 5. † IMPORTANT: Healthcare providers are responsible for keeping current and ...

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