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*Eligibility required. See Terms and Conditions.
CoriumCares provides eligible patients with an ADHD medication assistance program for easier access to AZSTARYS.
All fields are required unless otherwise noted. You must be 18 years or older to complete this form. If you are less than 18 years, a caregiver may complete this form on your behalf.
Is the patient covered by private or commercial insurance (not government-funded insurance)?
Is the patient 6 years of age or older?
Some insurance plans require additional information from your child's doctor before
they will cover AZSTARYS. Be sure to check that the doctor or pharmacist submits all
required information to your insurance company as soon as possible so that approval
for your prescription isn't delayed. CoriumCares does not currently have a patient
assistance program or any other financial assistance programs beyond the savings offer.
Call 1-800-910-8432 to
speak with
someone from
CoriumCares.
You can also ask your child's healthcare provider for a Starter Kit.
ADHD, attention deficit hyperactivity disorder.
AZSTARYS is a federally controlled substance (CII) because it can be abused or lead to dependence. Keep AZSTARYS in a safe
place to prevent misuse and abuse. Selling or giving away AZSTARYS may harm others and is against the law.
Tell your healthcare provider if you or your child have ever abused or been dependent on alcohol, prescription medicines, or
street drugs.
Do not take AZSTARYS if you or your child are:
The most common side effects of AZSTARYS include:
These are not all the possible side effects of AZSTARYS. Call your doctor for medical advice about side effects.
AZSTARYS is a central nervous system (CNS) stimulant prescription medicine for the treatment of Attention Deficit Hyperactivity
Disorder (ADHD) in people 6 years of age and older. AZSTARYS may help increase attention and decrease impulsiveness and hyperactivity in people with ADHD.
For additional safety information, click here for Prescribing Information and Medication Guide and discuss with your doctor.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch,
or call 1-800-FDA-1088.
AZSTARYS is a central nervous system (CNS)
stimulant prescription medicine for the treatment
of Attention Deficit Hyperactivity Disorder (ADHD)
in people 6 years of age and older. AZSTARYS may
help increase attention and decrease impulsiveness
and hyperactivity in people with ADHD.
AZSTARYS is a federally controlled substance (CII) because it can be abused or
lead to dependence. Keep AZSTARYS in a safe place to prevent misuse and
abuse. Selling or giving away AZSTARYS may harm others and is against the law.
Tell your healthcare provider if you or your child have ever abused or been
dependent on alcohol, prescription medicines, or street drugs.
Tell your healthcare provider if you or