Free 4-week trial

A SPECIALTY PHARMACY EXPERIENCE WITH LESS HASSLE FOR YOUR PATIENTS

With GOCOVRI Onboard®, we're changing the specialty pharmacy experience by supporting you and your patients with ONE direct line of contact (1-844-GOCOVRI) and timely fulfillment

Regardless of formulary status, ~90% of prescriptions have been processed and approved1*

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YOU

ONE Prescription Form

You can offer your patients a free 4-week trial*

To get patients started, complete and sign the Prescription Form together, before your patients leave your office. Then fax (1-844-826-7626) the form to GOCOVRI Onboard®.

Free trial ›

Download Prescription Form

  • *No purchase of GOCOVRI® or enrollment into GOCOVRI Onboard® is required.

GOCOVRI ONBOARD®

ONE line of contact

GOCOVRI Onboard® supports:

  • Benefits verification
  • Electronic submission of prior authorizations through CoverMyMeds®
  • Overnight deliveries each month

Financial assistance is also available:

  • Patients who participate in the GOCOVRI® Co-pay Assistance Program pay $20 per prescription
  • For patients receiving GOCOVRI®, ~75% of all patients paid $25 or less per prescription and ~92% paid $100 or less1‡
  • Under- or uninsured patients may be eligible for GOCOVRI® Patient Assistance Program

Call 1-844-GOCOVRI (8 AM-8 PM ET, M-F).

  • †This offer is valid only for patients who have commercial (nongovernment-funded) insurance and must meet eligibility requirements. Additional terms and conditions apply.
  • ‡Based on specialty pharmacy data 1/1/2019–6/30/2019.
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Your patients

ONE dedicated team

Patients will receive their monthly shipment of GOCOVRI® as well as ongoing support from ONE specialty pharmacy to:

  • Answer any questions they may have
  • Help support continuity of care
  • Provide monthly check-ins, following up on the initial titration, refills, and adherence support

Ask your patients to call 1-844-GOCOVRI (8 AM-8 PM ET, M-F).

  • *Based on specialty pharmacy data 1/1/18-12/31/18.

5 EASY STEPS TO GET PATIENTS STARTED

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Fill out, sign, and fax the Prescription Form to GOCOVRI Onboard® at 1-844-826-7626

Be sure to complete the Prescription Form before your patient leaves the office

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A benefits verification is initiated

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If a Prior Authorization (PA) is required, GOCOVRI Onboard® will initiate the PA and send to your office via CoverMyMeds®

GOCOVRI Onboard® may reach out to you to ensure timely completion

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The Specialty Pharmacy will call your patient to schedule next-day delivery of GOCOVRI®

Note: your patients will need to speak with the specialty pharmacy over the phone in order to schedule their first delivery

If the specialty pharmacy is not able to reach the patient, they may reach out to you to help facilitate contact

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The Specialty Pharmacy will follow up monthly to schedule recurring deliveries


Prescription forms and templates

Download
Prescription Form

The Prescription Form both signs your patient up for GOCOVRI Onboard® and serves as a prescription for GOCOVRI®.

Download Letter of
Medical Necessity

Sample Letter of Medical Necessity

Download Letter
of appeal

Sample Letter of Appeal

Register for gocovri® updates

Sign up to stay informed, or call 1-844-GOCOVRI and learn more about GOCOVRI® in your area.

Specialty*:
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Thank you

Your registration is complete and you are now signed up to receive updates on GOCOVRI® (amantadine) extended release capsules. An email will be sent to your inbox confirming your registration.

You can also call 1-844-GOCOVRI to learn more about GOCOVRI® in your area.

Important Safety Information

Indication

GOCOVRI® (amantadine) extended release capsules is indicated for the treatment of dyskinesia in patients with Parkinson’s disease receiving levodopa-based therapy, with or without concomitant dopaminergic medications.

Contraindications

GOCOVRI is contraindicated in patients with creatinine clearance below 15 mL/min/1.73 m2.

Warnings and Precautions

Falling Asleep During Activities of Daily Living and Somnolence: Patients treated with Parkinson’s disease medications have reported falling asleep during activities of daily living. If a patient develops daytime sleepiness during activities that require full attention (e.g., driving a motor vehicle, conversations, eating), GOCOVRI should ordinarily be discontinued or the patient should be advised to avoid potentially dangerous activities.

Suicidality and Depression: Monitor patients for depression, including suicidal ideation or behavior. Prescribers should consider whether the benefits outweigh the risks of treatment with GOCOVRI in patients with a history of suicidality or depression.

Hallucinations/Psychotic Behavior: Patients with a major psychotic disorder should ordinarily not be treated with GOCOVRI because of the risk of exacerbating psychosis. Observe patients for the occurrence of hallucinations throughout treatment, especially at initiation and after dose increases.

Dizziness and Orthostatic Hypotension: Monitor patients for dizziness and orthostatic hypotension, especially after starting GOCOVRI or increasing the dose.

Withdrawal-Emergent Hyperpyrexia and Confusion: Rapid dose reduction or abrupt discontinuation of GOCOVRI, may cause an increase in the symptoms of Parkinson’s disease or cause delirium, agitation, delusions, hallucinations, paranoid reaction, stupor, anxiety, depression, or slurred speech. Avoid sudden discontinuation of GOCOVRI.

Impulse Control/Compulsive Behaviors: Patients may experience urges (e.g. gambling, sexual, money spending, binge eating) and the inability to control them. It is important for prescribers to ask patients or their caregivers about the development of new or increased urges. Consider dose reduction or stopping medications.

Adverse Reactions

The most common adverse reactions (>10%) were hallucination, dizziness, dry mouth, peripheral edema, constipation, fall, and orthostatic hypotension.

View the full Prescribing Information.

Indication

GOCOVRI® (amantadine) extended release capsules is indicated for the treatment of dyskinesia in patients with Parkinson’s disease receiving levodopa-based therapy, with or without concomitant dopaminergic medications.

  • Reference: 1. Data on File. Adamas Pharma LLC, Emeryville, CA.