Support Program Resources for Your Patients | Acadia Connect®

The information and tools here can be important resources in securing treatment for your patients or residents, and getting them started on that treatment right away.

formulary lookup.

Check NUPLAZID approvals by your patient’s insurance provider to get a better sense of the cost and coverage options available to them.

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prior authorization.

Complete prior authorization that may be necessary to secure NUPLAZID coverage with your patient’s insurance provider.

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This information is intended as a guide. Coverage and costs may differ between private and government insurance plans, and are subject to change. Please check with the health plan to confirm coverage for individual patients.

useful resources.
LETTER OF APPEAL: Your patient may need a letter of appeal if a previous authorization request has been denied.

LETTER OF MEDICAL NECESSITY: You may need to document a patient’s medical necessity for treatment to get insurance coverage.

Below are tools and downloadable resources that can help you more easily prescribe NUPLAZID and introduce patients, residents, and caregivers to the benefits of Acadia Connect. If the patient or caregiver is present, make sure they sign the HIPAA authorization when completing the Treatment & Service Request Form.

Treatment & Service Request Form

Prescribe NUPLAZID, request a free 14-day supply, and enroll your patients or residents in Acadia Connect by completing this form online or by downloading it below and filling out the PDF.

Letter of Medical Necessity

Please use the template letter below to provide an outline of your patient's medical history and diagnosis when requesting coverage for NUPLAZID.

DOWNLOAD ( DOCX)

Letter of Appeal

Please use the template letter below to provide an outline of your patient’s medical history and diagnosis when requesting reconsideration for prior authorizations for NUPLAZID.

DOWNLOAD ( DOCX)

Acadia Connect Brochure

The Acadia Connect brochure is a valuable resource for sharing important program support information with your patients or residents.

DOWNLOAD ( PDF)

enroll your patients or residents.

To start these services for you and your patients or residents, complete our simple online prescription and enrollment form.

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Important Safety Information and Indication for NUPLAZID^® (pimavanserin)

WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death.
NUPLAZID is not approved for the treatment of patients with dementia who experience psychosis unless their hallucinations and delusions are related to Parkinson’s disease.

Contraindication: NUPLAZID is contraindicated in patients with a history of a hypersensitivity reaction to pimavanserin or any of its components. Rash, urticaria, and reactions consistent with angioedema (e.g., tongue swelling, circumoral edema, throat tightness, and dyspnea) have been reported.
Warnings and Precautions: QT Interval Prolongation

NUPLAZID prolongs the QT interval. The use of NUPLAZID should be avoided in patients with known QT prolongation or in combination with other drugs known to prolong QT interval (e.g., Class 1A antiarrhythmics, Class 3 antiarrhythmics, certain antipsychotics or antibiotics).
NUPLAZID should also be avoided in patients with a history of cardiac arrhythmias, as well as other circumstances that may increase the risk of the occurrence of torsade de pointes and/or sudden death, including symptomatic bradycardia, hypokalemia or hypomagnesemia, and presence of congenital prolongation of the QT interval.

Adverse Reactions: The adverse reactions (≥2% for NUPLAZID and greater than placebo) were peripheral edema (7% vs 2%), nausea (7% vs 4%), confusional state (6% vs 3%), hallucination (5% vs 3%), constipation (4% vs 3%), and gait disturbance (2% vs <1%).
Drug Interactions:

Coadministration with strong CYP3A4 inhibitors increases NUPLAZID exposure. Reduce NUPLAZID dose to 10 mg taken orally as one tablet once daily.
Coadministration with strong or moderate CYP3A4 inducers reduces NUPLAZID exposure. Avoid concomitant use of strong or moderate CYP3A4 inducers with NUPLAZID.

Indication

NUPLAZID is indicated for the treatment of hallucinations and delusions associated with Parkinson’s disease psychosis.

Dosage and Administration

Recommended dose: 34 mg capsule taken orally once daily, without titration, with or without food.

NUPLAZID is available as 34 mg capsules and 10 mg tablets.

Please read the full Prescribing Information, including Boxed WARNING.

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