Downloadable forms and documents to assist you with reimbursement processes for LENVIMA®
Use the specialty pharmacy Intake Form to send a prescription for Lenvima to Accredo, Biologics, CVS Specialty, Onco360, Optum or US Bioservices to initiate a benefits investigation which may determine what coverage and assistance options are available based on eligibility criteria.
The LENVIMA® Eisai Assistance Program Enrollment Form initiates a benefits investigation to help patients understand their coverage for LENVIMA® and where assistance may be available. It can also be used for patients to apply for the Eisai Assistance Program and to opt-in for patient communications. The enrollment form, insurance information, financial documentation, signature of the prescribing healthcare professional, and patient's signature are required for the form to be considered complete. This form has been annotated to include specific information as it relates to LENVIMA®.
This brochure outlines Specialty Pharmacy and reimbursement support information.
These independent foundations offer financial and other assistance (education, counseling, support groups, etc.) to patients.*
* The organizations listed are independent from Eisai. Eisai does not influence or control the operations or eligibility criteria for these independent programs. This information is provided for informational purposes only.
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.
LENVIMA is indicated:
For more information about LENVIMA please see available full Prescribing Information.
This information is intended for use by our 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.
LENVIMA® is a registered trademark used by Eisai under license from Eisai R & D Management Co., Ltd.