Financial Assistance
Eisai Assistance Program
The Eisai Assistance Program can provide information to patients and healthcare professionals about coverage for HALAVEN®, as well as information about programs that may help eligible patients afford their medication. Depending on your financial situation and clinical status, resources may be available to help with patient’s costs for HALAVEN®.
The Eisai Assistance Program can also provide information about the HALAVEN® Patient Assistance Program which provides support to eligible patients who need assistance paying for HALAVEN®. This program provides HALAVEN® at no cost to patients who meet program eligibility criteria.
Have Your Physician’s Office Contact Us
Eisai Assistance Program
Phone: 1-866-61- EISAI (1-866-613-4724)
Fax: 1-866-57-EISAI (1-866-573-4724)
Monday – Friday, 8am – 8pm ET
HALAVEN® $0 Co-Pay Program
Overview
The HALAVEN $0 Co-Pay Program assists eligible commercially insured patients with their out-of-pocket costs for HALAVEN up to $18,000 per year. Eligible patients may pay as little as $0 per month. Depending on your insurance plan, you could have additional financial responsibility for any amounts over Eisai's maximum liability.
How the Program Works
Step 1: Submit a completed enrollment form signed by both you and your physician.
Step 2: If you are eligible you will be sent a Welcome Letter and a card. This card should be given to your providers’ office so that it can be used to process the appropriate payment.
Step 3: Fax the Explanation of Benefits (EOB) or detailed specialty Pharmacy Receipt for the Halaven claim to 844-745-2350. The following information should be included:
- Your full name
- Date of service
- Cost of the medication
- Amount covered by the insurance
- Your financial responsibility: deductible; co-payment; and co-insurance
Step 4: If your claim is approved, the appropriate funding based on the your out of pocket costs will be loaded onto the your card and a confirmation letter will be sent to you and your provider
For questions about the savings program, please call 1-866-61-EISAI (1-866-613-4724).
Eligibility Criteria
Good toward the purchase of HALAVEN® prescriptions. No substitutions permitted. Not available to patients enrolled in state and federal healthcare programs, including Medicare, Medicaid, Medigap, VA, DoD or TRICARE. Offer only available to patients with private, commercial insurance. May not be combined with any other coupon, discount, prescription savings card, free trial or other offer. Federal law prohibits the selling, purchasing, trading, or counterfeiting of this card. Such activities may result in imprisonment of 10 years, fines up to $25,000, or both. Void outside the USA and where prohibited by law. Eisai Inc. reserves the right to rescind, revoke, or amend this offer at any time without notice. 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 on third-party payors. 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 HALAVEN®. Use of the card for any one purchase does not obligate the patient to make future purchases of HALAVEN® or any other product. This offer will expire November 20, 2021.
HALAVEN® Patient Assistance Program
Eisai has created the HALAVEN® Patient Assistance Program for customers who need assistance paying for HALAVEN®. This program provides HALAVEN® at no cost to patients who meet program eligibility criteria.
Have your healthcare provider call the HALAVEN® Patient Assistance Program at 1-866-61-EISAI (1-866-613-4724) to determine eligibility. The hours of operation are 8 AM to 8 PM ET, Monday through Friday.
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.
Do You Need Educational Assistance?
Is HALAVEN® Right for Me?
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.
Indication
Who is HALAVEN® (eribulin mesylate) injection for?
HALAVEN® is a prescription medicine used to treat adults with breast cancer that has spread to other parts of the body, and who have already received other types of anticancer medicines after the cancer has spread.
HALAVEN® is also for adults with liposarcoma that cannot be treated with surgery or that has spread to other parts of the body, and who have received treatment with a certain type of anticancer medicine.
Important Safety Information
What safety information do I need to know about HALAVEN®?
HALAVEN® can cause serious side effects, including:
- Low white blood cell count (neutropenia). This can lead to serious infections that could lead to death. Your health care provider will check your blood cell counts. Call your health care provider right away if you develop fever (temperature above 100.5°F), chills, cough, or burning or pain when you urinate, as any of these can be symptoms of infection
- Numbness, tingling, or pain in your hands or feet (peripheral neuropathy). Peripheral neuropathy is common with HALAVEN® and sometimes can be severe. Tell your health care provider if you have new or worsening symptoms of peripheral neuropathy
- Your health care provider may delay or decrease your dose or stop treatment with HALAVEN® if you have side effects
Before you receive HALAVEN®, tell your health care provider about all of your medical conditions, including if you
- have liver or kidney problems
- have heart problems, including a problem called congenital long QT syndrome
- have low potassium or low magnesium in your blood
- are pregnant or plan to become pregnant. HALAVEN® can harm your unborn baby. Tell your health care provider right away if you become pregnant or think you are pregnant during treatment with HALAVEN®. Females who are able to become pregnant should use an effective form of birth control during treatment with HALAVEN® and for at least 2 weeks after the final dose of HALAVEN® and males should use an effective form of birth control when having sex with female partners who are able to become pregnant during treatment with HALAVEN® and for 3 1/2 months (14 weeks) after the final dose of HALAVEN®
- are breastfeeding or plan to breastfeed. It is not known if HALAVEN® passes into your breast milk. Do not breastfeed during treatment with HALAVEN® and for 2 weeks after the final dose of HALAVEN®
Tell your health care provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
What are the possible side effects of HALAVEN®?
HALAVEN® can cause changes in your heartbeat (called QT prolongation). This can cause irregular heartbeats. Your health care provider may do heart monitoring (electrocardiogram or ECG) or blood tests during your treatment with HALAVEN® to check for heart problems.
The most common side effects of HALAVEN® in adults with breast cancer include low white blood cell count (neutropenia), low red blood cell count (anemia), weakness or tiredness, hair loss (alopecia), nausea, and constipation.
The most common side effects of HALAVEN® in adults with liposarcoma include tiredness, nausea, hair loss (alopecia), constipation, stomach pain, and fever.
Your health care provider will do blood tests before and during treatment while you are taking HALAVEN®. The most common changes to blood tests in adults with liposarcoma include low white blood cell count (neutropenia) and decreased blood levels of potassium or calcium.
For more information about HALAVEN®, talk to your doctor or see full prescribing information.
HALAVEN® is available by prescription only.
You are encouraged to report negative side effects of prescription
drugs to the FDA.
Visit http://www.FDA.gov/medwatch or call 1-800-FDA-1088.
The information contained herein is provided for educational purposes only and is not intended to replace discussions with a health care professional. All decisions regarding patient care must be made with a health care 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.
HALAVEN® is a registered trademark used by Eisai under license from Eisai R & D Management Co., Ltd.
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