*Eligibility required. See Terms and Conditions. A maximum benefit may apply.

AZSTARYS™ copay savings card

Sign up for copay support

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.

To start, tell us a little about the patient.

Is the patient covered by private or commercial insurance (not government-funded insurance)?

Is the patient 6 years of age or older?

Having trouble getting access to AZSTARYS?

Ask your child's doctor
about getting AZSTARYS
approved through your
insurance

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 the 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.

Questions about AZSTARYS?

Call 1-800-910-8432 to
speak with
someone from
CoriumCares.

Just getting started?

To learn more about AZSTARYS, download the

You can also ask your child's doctor for a Welcome Kit.

ADHD, attention deficit hyperactivity disorder.

Important Safety Information

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.

Who should not take AZSTARYS?

Do not take AZSTARYS if you or your child are:

  • allergic to serdexmethylphenidate, methylphenidate, or any of the ingredients in AZSTARYS.
  • taking or have stopped taking within the past 14 days a medicine used to treat depression called a monoamine oxidase
    inhibitor (MAOI).

Serious problems can occur while taking AZSTARYS. Tell your healthcare provider:

  • if you or your child have heart problems, heart defects, high blood pressure, or a family history of these problems. Sudden death has
    occurred in people with heart problems or defects taking stimulant medicines. Sudden death, stroke and heart attack have happened
    in adults taking stimulant medicines. Your doctor should check you or your child carefully for heart problems before starting
    AZSTARYS. Since increases in blood pressure and heart rate may occur, the doctor should regularly check these during treatment.
    Call your healthcare provider right away or go to the nearest hospital emergency room if you or your child have any signs of
    heart problems such as chest pain, shortness of breath, or fainting while taking AZSTARYS.
  • if you or your child have mental (psychiatric) problems, or a family history of suicide, bipolar illness, or depression. New or worse
    behavior and thought problems or new or worse bipolar illness may occur. New psychotic symptoms (such as seeing or hearing
    things that are not real, believing things that are not true, being suspicious) or new manic symptoms may occur. Call your
    healthcare provider right away if there are any new or worsening mental symptoms or problems during treatment.
  • if you or your child develop painful and prolonged erections (priapism), seek medical help right away. Priapism has occurred with
    methylphenidate (AZSTARYS). Because priapism can cause long-lasting damage, it should be checked by a healthcare professional
    right away.
  • if you or your child have circulation problems in fingers and toes (called peripheral vasculopathy, including Raynaud’s phenomenon).
    Fingers or toes may feel numb, cool, painful, sensitive to temperature, and/or change color from pale, to blue, to red. Call your
    healthcare provider right away if any signs of unexplained wounds appear on fingers or toes while taking AZSTARYS.
  • if your child is having slowing of growth (height and weight). Your child should have his or her height and weight checked often
    while taking AZSTARYS.
  • if you or your child are pregnant or plan to become pregnant. It is not known if AZSTARYS may harm your unborn baby.
  • if you or your child are breastfeeding or plan to breastfeed. AZSTARYS passes into breast milk. Talk to your healthcare provider about
    the best way to feed your baby if you take AZSTARYS.

What are possible side effects of AZSTARYS?

The most common side effects of AZSTARYS include:

  • decreased appetite
  • nausea
  • indigestion
  • weight loss
  • dizziness
  • mood swings
  • increased blood pressure
  • trouble sleeping
  • vomiting
  • stomach pain
  • anxiety
  • irritability
  • increased heart rate

These are not all the possible side effects of AZSTARYS. Call your doctor for medical advice about side effects.

What is AZSTARYS?

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.

What is AZSTARYS?

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.

IMPORTANT SAFETY INFORMATION

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