BELVIQ® or BELVIQ XR® may be covered by some Insurance Companies, Medicare and Medicaid. Coverage may change based on the specific type of insurance you have. Ask your Pharmacist if your insurance will cover BELVIQ® or BELVIQ XR® .
Eisai offers financial assistance to eligible patients who can’t afford BELVIQ® or BELVIQ XR®. The Eisai Assistance Program can assist you with understanding your options and can be reached at 1-866-61-EISAI or 1-866-613-4724.
Commercial insurance companies include organizations such as health maintenance organization (HMO) plans, managed care organizations, indemnity plans and others. Several plans may provide coverage for BELVIQ® or BELVIQ XR® (lorcaserin HCl) CIV. However, specific coverage requirements and limits depend on a patient’s benefits and will vary based on your plan type and healthcare provider. Contact your healthcare provider to understand if you will have coverage for BELVIQ® or BELVIQ XR® treatments.
Commercially insured patients may be eligible for the Savings Card Program for BELVIQ® or BELVIQ XR®.
To learn more about this program, click here.
Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease. Part D covers prescription drugs that you get at pharmacy. For Medicare patients, weight-loss drugs generally fall under Part D benefits, which often exclude prescription weight-loss drugs from coverage. Medicare patients may consider the option of upgrading Part D benefits to an enhanced Part D benefit plan that perhaps would cover weight-loss drugs. It is important to investigate whether the particular plan you are considering includes prescription weight-loss drugs on its Preferred Drug List or Drug Formulary. Your Pharmacist will be able to help you understand how or if Medicare may cover BELVIQ® or BELVIQ XR® treatments.
Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Each state sets its own coverage and eligibility rules for its Medicaid program. Weight-loss drugs, such as BELVIQ® and BELVIQ XR®, are a class of drugs that Medicaid does not generally cover. However, coverage and patient out-of-pocket costs will vary from state to state. Your Pharmacist will be able to help you understand if your state Medicaid plan will cover BELVIQ® or BELVIQ XR®.
If you are planning to see your doctor to determine if prescription weight-loss medication is appropriate for you or if you have recently received a prescription for a weight-loss medicine, you may want to investigate your health insurance coverage for this type of drug prior to visiting the pharmacy.
Below is the information you will first need to gather to determine your coverage in regard to prescription weight-loss drugs
Insurance company’s name and phone/fax number
Policy number or employer’s plan number
Name and date of birth of the primary insured person
Insurance company claims representative and/or contact person
Insurance company Website address (Many insurance companies maintain websites that include plan information, such as the preferred drug list and the process for appealing a denial. Sometimes you may be required to sign up to view certain areas of the Website. If you require assistance, you may always call your insurance company’s member services telephone number and ask to be walked-through the sign-up process.)
Below are important questions to ask your insurance company’s claims representative when researching the coverage provided by your plan for prescription weight-loss drugs
Which prescription weight-loss drugs are specifically covered under my plan? Are any prescription weight-loss drugs excluded from coverage (listed as an exclusion) under my plan?
What requirements are necessary to be met for weight-loss prescription drug coverage? There may be requirements in the following:
Body Mass Index (BMI)
If applicable, list prior attempts for weight loss using diet and exercise
Other medical conditions you may have
What is the co-payment for the drug, if it is approved?
If you called your insurance company and were told that prescription weight-loss drugs are not covered under your plan, or if you tried to fill a prescription for your weight-loss medication and you learned that the drug is not covered, do not become discouraged. This is called a denial of coverage or denial of claim. The key thing to remember is that you may have the right to appeal this decision. First, it is important to understand the reason your claim for the weight-loss drug was denied. Do not be afraid to call your insurance company contact to request a detailed explanation in writing as to why you were denied. Once you receive the explanation, read it carefully. Denials may be categorized as either “Not Medically Necessary” or “Excluded Covered Outpatient Product.”
Sample letters for appealing a denial of coverage are available in Patient Resources.
If the denial was categorized as “Not Medically Necessary,” you can speak to your doctor to ask him/her to complete a “Physician Appeal Letter” explaining why he/she prescribed the drug for you and why he/she believes it is medically necessary. If applicable, you can remind your doctor of your previous unsuccessful attempts to achieve weight loss and any weight-related medical conditions from which you suffer. If your doctor agrees to submit the Physician Appeal Letter on your behalf, you may want to follow up with his/her office staff a week later to ensure that the appeal letter has been submitted to your insurance company.
In the event the denial was categorized as an “Excluded Covered Outpatient Therapy,” double check that your plan allows for coverage of prescription weight-loss products. If it is an excluded covered outpatient therapy, you may be able to appeal this decision. If you are interested in appealing this decision you may write a letter to you plan; you will also need a letter of appeal from your physician. To appeal the denial, speak with your doctor and ask that he/she completes a “Physician Appeal Letter.” Let him/her know that appealing this denial is important to you. If your doctor agrees to submit the Physician Appeal Letter on your behalf, you may want to follow up with his/her office staff a week later to ensure that the appeal letter has been submitted to your insurance company.
Sample letters and instructions are available in Patient Resources.
If prescription weight-loss drugs are not covered by your current insurance plan and appeals for coverage of the drug are unsuccessful, you may want to consider upgrading your insurance or looking into other plans that may be available to you.
If your insurance plan is offered to you through your employer, your employer may not be aware of the fact that prescription weight-loss drugs are not covered by the plan and that employees are impacted by this lack of coverage. One option you may want to consider is to write a letter to your Human Resources (HR) Manager or Employee Benefits Manager to request that he/she consider including such coverage during the next plan review period.
For non-Medicare patients, prescription weight-loss drug coverage may be found by exploring other insurance options, such as a state exchange insurance plan or a different employer-based insurance option. However, it will be important to investigate the Preferred Drug List or Drug Formulary for the specific plan you are considering to ensure that prescription weight-loss drugs are included.
Health Savings Accounts (HSAs), Co-pay Assistance Programs, and Patient Assistance Programs (PAPs) are also options to explore to help make your prescription weight-loss therapy more affordable. HSAs are set up in conjunction with high-deductible health plans. The dollars you deposit in a HSA are not subject to federal taxes at the time of deposit. This allows your buying power to go further. You may want to discuss this option with your tax professional. Co-pay assistance cards are sponsored by drug manufacturers and are not income-based. A co-pay assistance card may be available for the particular weight-loss drug you have been prescribed. You may ask your pharmacist if such a program exists or search the internet for the drug’s brand name and the terms “co-pay assistance.” Learn about co-pay assistance cards here.
If available, Patient Assistance Programs (PAPs) may significantly reduce out of pocket drug expense. PAPs are sponsored by pharmaceutical manufacturers to provide free or low-cost medications to people who cannot afford to buy their medicine. Learn about Patient Assistance Programs for BELVIQ® here.
Beneﬁt: Medical service or product for which your insurance will pay.
BMI (Body Mass Index): is a measurement tool that compares your height to your weight and gives you an indication of whether you are overweight, underweight, or at a healthy weight for your height. BMI is calculated by dividing weight in pounds (lbs) by height in inches (in) squared and multiplying by a conversion factor of 703. You may also use an online BMI calculator like the one sponsored by the Mayo Clinic, which can be found at: www.mayoclinic.org/bmi-calculator/itt-20084938.
Carrier: Insurance company or HMO oﬀering a health plan.
Claim: A notice to the insurance company that a person received care covered by the plan. A claim also may be a request for payment and will state so.
Comorbid Conditions: The presence of one or more additional disorders (or diseases) co-occurring with a primary disease or disorder. Some examples of weight-related comorbid conditions are high blood pressure (hypertension), high cholesterol (hypercholesterolemia), high blood sugar (Type II diabetes), temporary loss of breathing during sleep (sleep apnea), arthritic joints (osteoarthritis), heart disease (cardiovascular disease) and gallbladder disease.1
Co-pay or Co-payment: The insured individual's portion of the cost, usually a ﬂat dollar amount. Under many plans, co-payments are made at the time you pick up the medication(s)
Co-payment Assistance Program: A program sponsored by a drug manufacturer that provides a discount on the out-of-pocket cost of a brand-specific drug for a specified period of time.
Coverage: What the health plan does pay for.
Covered Expenses: What the insurance company will consider paying for as deﬁned in the health plan. For example, under some plans generic prescriptions are covered expenses, while brand name prescriptions may be covered at a diﬀerent reimbursement rate or not at all.
Denial of Coverage/Claim: Refusal by an insurance company to pay for healthcare services or products.
Dependents: Spouse and/or unmarried children under the age of 26 (whether natural, adopted, or step) of an insured.
Exclusion: Medical service or product that is not covered by an individual's insurance plan.
Health Savings Account (HSA): A tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in certain types of health plans. The funds contributed to an account are not subject to federal income tax at the time of deposit.
Patient Assistance Program: Program sponsored by a foundation or pharmaceutical manufacturer that provides free or low-cost drugs to patients who qualify medically and financially.
Primary Care Provider (PCP): A healthcare professional who is responsible for monitoring an individual's overall healthcare needs. Typically, a PCP serves as a "quarterback" for an individual's medical care, referring the individual to more specialized physicians for care.
1. Fujioka K. Current and emerging medications for overweight or obesity in people with comorbidities. Diabetes, Obesity & Metabolism. 2015;17(11):1021-1032. doi:10.1111/dom.12502
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 a FDA-approved prescription weight-loss medication that, when used with diet and exercise, can help some adults (Body Mass Index [BMI] ≥27 kg/m²) living with extra weight, with a weight-related medical problem, or adults living with obesity (BMI≥30 kg/m²), lose weight and keep it off.
It is not known if BELVIQ/BELVIQ XR when taken with other prescription, over-the-counter, or herbal weight-loss products is safe and effective. It is not known if BELVIQ/BELVIQ XR changes your risk of heart problems, stroke, or death due to heart problems or stroke.
BELVIQ®/BELVIQ XR® is a federally controlled substance (CIV) because they may be abused or lead to drug dependence.
For more information about BELVIQ®/BELVIQ XR® talk to your Healthcare Provider and see the full Product Information.
You are encouraged to report negative side effects of prescription drugs to the FDA.
The information contained herein is provided for educational purposes only and is not intended to replace discussions with a healthcare professional. All decisions regarding patient care must be made with a healthcare professional, considering the unique characteristics of the patient.
This site is intended for residents of the United States only. Any products discussed herein may have different product labeling in different countries.
BELVIQ® and BELVIQ XR® are registered trademarks of Eisai Inc.