Have questions about your insurance coverage?
FYCOMPA® (perampanel) may be covered by commercial insurance companies, Medicare, and Medicaid. Coverage may vary significantly by insurance company, specific health insurance plan, and patient. Insurance companies can base coverage decisions on formal policies or make decisions on a case-by-case basis. Ask your pharmacist or insurance company whether your insurance will cover FYCOMPA.
TYPES OF INSURANCE
COMMERCIAL INSURANCECommercial insurance is provided by nongovernment health plans such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Many people purchase commercial health insurance through their employer’s health plan, or you can purchase an individual policy directly from commercial insurance providers. The exact coverage you receive depends on the specific policy that you purchase.
Several plans may provide coverage for FYCOMPA. Contact your pharmacist or insurance company to find out if you will have coverage for FYCOMPA.
Commercially insured patients may be eligible for the FYCOMPA Instant Savings Card.
Medicare is a federal health insurance program for people who are 65 years or older, certain younger people with disabilities, and people with end-stage renal disease. Part D covers prescription drugs that you get at a pharmacy and take at home, including FYCOMPA. Your pharmacist will be able to help you understand how Medicare may cover FYCOMPA.
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 Medicaid programs. FYCOMPA is eligible for coverage under most state Medicaid programs. However, coverage and patient out-of-pocket costs vary from state to state. Your pharmacist will be able to help you understand how your state Medicaid plan may cover FYCOMPA.
Insurance plans are not affiliated with or offered by Eisai.
DETERMINING YOUR COVERAGE
If you are planning to see your doctor to determine if FYCOMPA is right for you, or if you have recently received a prescription for FYCOMPA, you may want to investigate your health insurance coverage for this type of drug prior to visiting the pharmacy.
Before speaking with your insurance company, be sure to have your policy number or employer’s plan number handy. When speaking with the claims representative, here are some important questions to ask:
- Is prior authorization required for FYCOMPA?
- Are there any treatments I’m required to have tried prior to authorizing coverage of FYCOMPA?
- Will you require any documentation of treatments that I’ve tried but failed?
- If approved, what is the patient out-of-pocket cost for the drug?
WHAT CAN YOU DO IF YOU RECEIVE A DENIAL OF COVERAGE?
“PRIOR AUTHORIZATION REQUIRED” CATEGORIZATION
Prior authorization is a requirement for your physician to obtain approval from your health insurance plan prior to prescribing FYCOMPA. Speak to your healthcare provider for additional resources to address any prior authorization requirements.
“STEP THERAPY” CATEGORIZATION
Your insurer may ask if you have tried and failed another epilepsy therapy before approving coverage for FYCOMPA. In this case, it is important to include documentation of any previous treatments in your appeal letter. Ask your healthcare provider about documentation needs to address step therapy requirements.
APPEALING A DENIAL
If you called your insurance company and were told that FYCOMPA is not covered under your plan, or if you tried to fill a prescription for FYCOMPA and learned that the drug is not covered, this is called a denial of coverage or denial of claim. You may have the right to appeal this decision and request a detailed explanation in writing as to why you were denied.
Eisai cannot guarantee payment of any claim. Coding, coverage, and reimbursement may vary significantly by payer, plan, patient, and setting of care. Actual coverage and reimbursement decisions are made by individual payers following the receipt of claims. For additional information, customers should consult with their payers 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.
WHAT IS FYCOMPA® (perampanel)?
FYCOMPA is a prescription medicine used alone or with other medicines to treat partial-onset seizures with or without secondarily generalized seizures in people with epilepsy aged 4 and older and with other medicines to treat primary generalized tonic-clonic seizures in people with epilepsy aged 12 and older.
IMPORTANT SAFETY INFORMATION
FYCOMPA may cause mental (psychiatric) problems, including: new or worse aggressive behavior (including homicidal behavior), hostility, anger, anxiety, or irritability; being suspicious or distrustful (believing things that are not true); seeing objects or hearing things that are not there; confusion; difficulty with memory; other unusual or extreme changes in behavior or mood. Tell your healthcare provider right away if you have any new or worsening mental problems while taking FYCOMPA.
Like other antiepileptic drugs, FYCOMPA may cause suicidal thoughts or actions in a very small number of people, about 1 in 500. Call your healthcare provider right away if you have any of these symptoms, especially if they are new, worse, or worry you: thoughts about suicide or dying; new or worse depression; feeling agitated or restless; trouble sleeping (insomnia); acting aggressive; being angry, or violent; an extreme increase in activity and talking (mania); attempt to commit suicide; new or worse anxiety; panic attacks; new or worse irritability; acting on dangerous impulses; other unusual changes in behavior or mood. Suicidal thoughts or actions can be caused by things other than medicines. If you have suicidal thoughts or actions, your healthcare provider may check for other causes.
Pay attention to any changes especially sudden changes in mood, behaviors, thoughts, or feelings and keep all follow-up visits with your healthcare provider as scheduled. Call your healthcare provider between visits as needed, especially if you are worried about symptoms.
Do not stop FYCOMPA without first talking with your healthcare provider. Stopping suddenly can cause serious problems and can cause you to have seizures more often.
Before taking FYCOMPA, tell your healthcare provider about all of your medical conditions, including if you: have or have had depression, mood problems, aggressive or hostile behavior (for example, homicidal behavior), suicidal thoughts or behavior, or other psychiatric problems; have liver or kidney problems; drink alcohol; have abused prescription medicines, street drugs, or alcohol in the past; are pregnant or plan to become pregnant. It is not known if FYCOMPA will harm your unborn baby. If you become pregnant while taking FYCOMPA, talk to your healthcare provider about registering with the North American Antiepileptic Drug Pregnancy Registry (1-888-233-2334); are breastfeeding or plan to breastfeed. Talk to your healthcare provider about the best way to feed your baby if you take FYCOMPA and to decide if you will take FYCOMPA or breastfeed. You should not do both.
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Taking FYCOMPA with certain other medicines can cause side effects or reduce either drug’s benefit. These medicines include: birth control, carbamazepine, phenytoin, oxcarbazepine, rifampin, and St. John’s Wort.
What should I avoid while taking FYCOMPA?
Do not drive, operate heavy machinery, or do other dangerous activities until you know how FYCOMPA affects you. FYCOMPA may make you dizzy, sleepy, or tired. Do not drink alcohol or take other medicines that make you sleepy or dizzy until you talk to your healthcare provider. FYCOMPA taken with alcohol or medicines that cause sleepiness or dizziness may make your sleepiness or dizziness worse. FYCOMPA when taken with alcohol may also make your mood worse, increase anger, confusion, and depression.
FYCOMPA may cause other serious side effects, including: Dizziness, vertigo (sense of spinning), and problems walking normally. You may have problems walking normally if you are unsteady because you feel dizzy. These symptoms can increase when your dose of FYCOMPA is increased. Your risk of feeling dizzy and having problems walking normally may be higher if you are elderly; Sleepiness and tiredness; Increased risk of falls. Taking FYCOMPA can increase your chance of falling. These falls can cause serious injuries. Your risk of falling may be higher if you are elderly; A serious allergic reaction that may affect your skin or other parts of your body such as your liver, kidneys, heart, or blood cells. This allergic reaction can be life-threatening and can cause death. Call your healthcare provider right away if you have: a skin rash, hives; fever or swollen glands that do not go away; swelling of your face; shortness of breath; swelling of the legs; yellowing of the skin or whites of the eyes; or dark urine
The most common side effects of FYCOMPA include: dizziness; sleepiness; tiredness; irritability; falls; nausea and vomiting; weight gain; vertigo (sense of spinning); problems walking normally; problems with muscle coordination; headache; bruising; abdominal pain; anxiety
FYCOMPA is a controlled substance (CIII) because it can be abused or lead to drug dependence. Keep FYCOMPA in a safe place to protect it from theft and never give it to anyone else because it may harm them. Selling or giving away FYCOMPA is against the law.