The Eisai Assistance Program can provide information to patients and healthcare professionals about coverage for BELVIQ® or BELVIQ XR® and programs to help patients afford their medication. As a resource for you, Eisai has also developed an online portal to enable you to research your patients’ insurance coverage for BELVIQ® or BELVIQ XR®. The portal is easy to use and can quickly provide you BELVIQ® or BELVIQ XR® coverage information for your patients.
Click here to access the Provider Insurance Verification Portal for BELVIQ® or BELVIQ XR®.
The Eisai Assistance Program can also provide information about the Patient Assistance Program for BELVIQ® which provides support to customers who need assistance paying for BELVIQ®. This program provides BELVIQ® at low cost to financially needy patients who meet program eligibility criteria.
If your patients’ commercial insurance covers BELVIQ® or BELVIQ XR®, simply use this program to Save Up to $160, after paying $40 for BELVIQ® or $30 for BELVIQ XR®, on every 30 day supply.**
If your patient is paying cash or their commercial insurance, Medicare Part D or TRICARE does not cover BELVIQ® or BELVIQ XR®, we can help! Use this program to Save Up to $195 on every 30 day supply.**
* Savings Card is not available to patients who are eligible for state or federal health care programs. However, Medicare Part D and TRICARE beneficiaries whose coverage does not include BELVIQ® or BELVIQ XR® may use this card. See Complete Restrictions and Conditions of Use below and on back.
**On average savings card users with commercial coverage pay <=$66.00 and those without commercial coverage or who pay cash, or who have Medicare Part D or TRICARE whose coverage does not pay for BELVIQ® or BELVIQ XR® pay an average of <= $97.00 per month, based upon McKesson cost coverage data.
Good toward the purchase of prescriptions for BELVIQ® (lorcaserin HCI) CIV or BELVIQ XR® (lorcaserin HCI) CIV for up to 13 uses per year. Limited to 1 prescription per patient for any 30-day period. For patients with commercial insurance that covers the product, the patient pays the first $30 for BELVIQ XR or $40 for BELVIQ, and then Eisai Inc. will provide no more than $160 off the patient’s out-of-pocket costs per commercially insured, covered prescription. For patients paying cash who have commercial insurance that does not cover the product, Medicare Part D, TRICARE, or are uninsured, Eisai will provide no more than $195 off the patient’s cash price per 30 day fill. Save this card to reuse each month up to the expiration date or program discontinuation. No substitutions permitted.
Must be 18 years of age or older.
Not available to individuals eligible for federal healthcare programs that may cover prescription drugs, including Medicaid, CHAMPVA, the Department of Veterans Affairs healthcare program, or the Puerto Rico Government Health Insurance Plan, or any similar state or federal healthcare programs.
Medicare Part D and TRICARE patients whose insurance does NOT cover BELVIQ® or BELVIQ XR® may use this card if paying the full cash price for a prescription covered by this card and no claim is submitted to Medicare or TRICARE, or any other federal, state, or other governmental program. Out-of-pocket expenses incurred using this card cannot be applied towards Medicare Part D true out-of-pocket (TrOOP) expenses or TRICARE catastrophic cap.
Not valid for prescriptions for BELVIQ or BELVIQ XR reimbursed in full by any third-party payer.
Patients and pharmacies are responsible for disclosing to insurance carriers the redemption and value of the card and complying with any other conditions imposed by insurance carriers, third-party payers, or applicable law.
May not be combined with any other coupon, discount, prescription savings card, free trial, or other offer.
The value of this card is not contingent on any prior or future purchases.
The card is solely intended to provide savings on any purchase of BELVIQ or BELVIQ XR. Use of the card for any single purchase does not obligate the patient to make future purchases of BELVIQ or BELVIQ XR or any other product.
Void outside the USA, including US territories and where prohibited by law.
This card expires 08/31/2018.
This card is not an insurance program.
This card may not be accepted at all pharmacies.
Federal law prohibits the selling, purchasing, trading, or counterfeiting of this savings card; such activities may result in imprisonment of 10 years, fines of $250,000, or both.
Eisai Inc. reserves the right to rescind, revoke, or amend this offer without notice at any time.
Other restrictions apply.
Eisai has created the Patient Assistance Program for BELVIQ® for customers who need assistance paying for BELVIQ®. This program provides BELVIQ® at low cost to financially needy patients who meet program eligibility criteria.Patients can call the BELVIQ® Patient Assistance Program at 1-866-61-EISAI (1-866-613-4724) to determine eligibility. The hours of operation are Monday through Friday, 8 am to 8 pm ET. BELVIQ XR® is not available through the Patient Assistance Program at this time.
Eisai reserves the right, at its sole discretion, to discontinue the Patient Assistance Program or change the qualifications at any time. All patient information remains confidential. Product supply for the program depends upon availability.
Eisai cannot guarantee payment of any claim. Coding, coverage, and reimbursement may vary significantly by payor, plan, patient, and setting of care. Actual coverage and reimbursement decisions are made by individual payors following the receipt of claims. For additional information, customers should consult with their payors for all relevant coding, reimbursement, and coverage requirements. It is the sole responsibility of the provider to select the proper code and ensure the accuracy of all claims used in seeking reimbursement. All services must be medically appropriate and properly supported in the patient medical record.
BELVIQ®/BELVIQ XR® is indicated as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults with an initial body mass index (BMI) of 30 kg/m2 or greater (obese), or 27 kg/m2 or greater (overweight) in the presence of at least one weight-related comorbid condition (e.g., hypertension, dyslipidemia, type 2 diabetes).
This information is intended for use by healthcare professionals in the United States only. Eisai Inc. recognizes the Internet is a global communications medium; however, laws, regulatory requirements, and medical practices for pharmaceutical products vary from country to country. The Prescribing Information included here is not appropriate for use outside the United States. This site contains information about products that may have different product labeling in different countries. This site is published by Eisai Inc.
BELVIQ® and BELVIQ XR® are registered trademarks of Arena Pharmaceuticals GmbH.