Coffee spill

A SPECIALTY PHARMACY EXPERIENCE WITH LESS HASSLE FOR YOUR PATIENTS

With GOCOVRI Onboard, we're changing the specialty pharmacy experience by providing ONE direct line of contact (1-844-GOCOVRI) to ensure timely fulfillment

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

YOU

ONE treatment form

YOU

ONE treatment form

Before your patients leave your office, complete and sign the Treatment Form together. Then fax (1-844-826-7626) the form to GOCOVRI Onboard.

You will have the option of offering new eligible GOCOVRI patients A FREE 28-DAY TRIAL.

This will give you and your patients the opportunity to try GOCOVRI.†

  • No purchase or enrollment into GOCOVRI Onboard is required.
accordion arrow
gocovri onboard icon

GOCOVRI ONBOARD

ONE line of contact

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:

  • Eligible commercially insured patients may have a co-pay as low as $20
  • Over 75% of all patients paid $25 or less per prescription1*
  • 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. Additional terms and conditions apply.
accordion arrow
patient icon

YOUR PATIENTS

ONE dedicated team

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).

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

FORMS AND TEMPLATES

Download
Treatment Form

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

Download Letter
of appeal

Sample Letter of Appeal

Download Letter of
Medical Necessity

Sample 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
*Required
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.

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.