NeedyMeds

This program provides brand name medications at no or low cost.

Eisai Assistance Program

Provided by:

Eisai, Inc.

PO Box 29231 Phoenix, AZ 85038 TEL: 866-613-4724 ALT PHONE: FAX: 866-573-4724	Program Website

	Languages Spoken: English, Others By Translation Service

Patient assistance
applications

Medications

Aloxi Injection 0.25mg (palonosetron)

Eligibility Requirements

APPLICATION

MEDICATION

Insurance Status	Determined case by case
Those with Part D Eligible?	Not specified
Income	Not disclosed
Diagnosis/Medical Criteria	Not specified
US Residency Required?	Yes

Obtaining	Call
Receiving	Faxed to Doctor's office
Returning	Mail or fax
Doctor's Action	Complete section, sign
Applicant's Action	Complete section, sign, attach proof of income
Decision Communicated	Patient and Doctor notified of acceptance
Decision Timeframe	Within 24-48 hours

Amount/Supply	Varies
Sent To	Doctor's office or patient's home
Delivery Time	Within 2 business days
Refill Process	Doctor/doctor's office must contact company
Limit	Not specified
Re-application	New application yearly

Additional Information:

Eligibility determined on a case-by-case basis.
Insurance benefits, claims assistance and/or other reimbursement help is offered. If a patient has insurance and the medication is not covered, then they may still be eligible for some type of assistance.

Applications are temporarily not being accepted for Ontak, call the program to confirm as this is subject to change at any time.