| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | ||||||
Eisai Assistance Program (Belviq)This program provides brand name medications at no or low cost |
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Provided by: Eisai, Inc. |
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TEL: Closed Program |
Languages Spoken:
English, Spanish, Others By Translation Service
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Patient Assistance Applications |
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Generic Name Medications |
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Eligibility Requirements |
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| Insurance Status | May have insurance | |||||
| Those with Part D Eligible? | Yes | |||||
| Income | At or below 150% of FPL | |||||
| Diagnosis/Medical Criteria | Medically appropriate condition/diagnosis | |||||
| US Residency Required? | Must reside in the US, Puerto Rico or the USVI | |||||
Application |
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| Obtaining | Call, download or apply online | |||||
| Receiving | Complete online or by phone | |||||
| Returning | Fax, mail or via Online Portal | |||||
| Doctor's Action | Give prescription to patient or Fax in prescription | |||||
| Applicant's Action | Complete section and sign | |||||
| Decision Communicated | ||||||
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Medication |
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| Limit | ||||||
| Re-application | New application every 12 months | |||||
Additional Information |
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| Closed Program For more information please visit www.rxoutreach.org Eisai also offers a Savings Card Program to use at other pharmacies (restrictions apply). For information please visit www.belviq.com/patient/savings |
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| Updated February 18, 2020 | ||||||
