Coffee spill
Coffee spill

ADAMAS IS COMMITTED TO HELPING PD PATIENTS WHO HAVE BEEN PRESCRIBED GOCOVRI

GOCOVRI ONBOARD logo

A support program designed to help eligible patients gain access to GOCOVRI without delay

Benefits verification

Benefits Verification

Reimbursement support

Reimbursement Support

Financial assistance

Financial Assistance

Fulfillment

Fulfillment

Compliance and persistence

Compliance and Persistence

SUPPORT FOR GETTING ON BOARD WITH GOCOVRI*

Co-pay savings program

CO-PAY SAVINGS PROGRAM

GOCOVRI Onboard™ can help pay for your patient's share of GOCOVRI if your patient has a commercial health plan.

What is offered:

Pay no more than $20 per month for GOCOVRI.

Who is eligible:

Your patient may be eligible if he or she has a commercial health plan and a monthly co-pay or coinsurance. Your patient does not quality if he or she has a government plan like Medicaid or Medicare.

GOCOVRI Quickstart Program

QUICKSTART PROGRAM

GOCOVRI Onboard can provide your patient with GOCOVRI at no cost while your patient's health plan evaluates his or her insurance coverage.

What is offered:

A free 14-day supply of GOCOVRI. A second 14-day supply can be sent if extra time is needed to resolve insurance coverage. There is no purchase required to participate in the QuickStart Program.

Who is eligible:

Your patient may be eligible if his or her health plan takes longer than 5 business days to decide whether it will cover GOCOVRI. Your patient must be new to GOCOVRI.

Patient financial assistance program for underinsured and insured patients

PATIENT ASSISTANCE PROGRAM

GOCOVRI Onboard can help your patient get GOCOVRI at no cost if he or she has no insurance coverage.

What is offered:

GOCOVRI at $0.

Who is eligible:

Your patient may be eligible if he or she has no health insurance or if your patient's health plan does not cover GOCOVRI. Your patient must meet income and other eligibility requirements.


HOW TO GET YOUR PATIENTS ON BOARD

The Treatment Form both signs your patient up for GOCOVRI ONBOARD and serves as a prescription for GOCOVRI.

Download Treatment Form

FORMS AND TEMPLATES

Sample Letter of Appeal

Download Letter of appeal

Sample Letter of Medical Necessity

Download Letter of
Medical Necessity

REGISTER FOR GOCOVRI UPDATES

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

Make Selection
I authorize Adamas Pharmaceuticals, Inc., its affiliates, and its agents to communicate with me by email with information pertaining to Adamas products and services. I understand that I may revoke this authorization and choose not to receive information from Adamas by clicking the "unsubscribe" link at the bottom of the emails I receive from Adamas.
*Required.

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™ (amantadine) 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.

Drug Interactions

Other Anticholinergic Drugs: The dose of GOCOVRI should be reduced if atropine-like effects are observed.

Drugs Affecting Urinary pH: The pH of the urine has been reported to influence the excretion rate of amantadine. Monitor for efficacy or adverse reactions under conditions that alter the urine pH.

Alcohol: Concomitant use with alcohol is not recommended, as it may increase the potential for CNS effects such as dizziness, confusion, lightheadedness, and orthostatic hypotension.

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.