ELIGIBILITY CRITERIA & TERMS AND CONDITIONS
- Not available to patients enrolled in federal or state healthcare programs, including Medicare, Medicaid, Medigap, VA, DoD, or TRICARE
- Patients must have commercial insurance
- Cash-paying patients are excluded
- Patients must be 18 years or older to use the card
TERMS AND CONDITIONS
- Good toward the purchase of DAYVIGO prescriptions
- Eligible commercially insured patients may pay as little as $10 of out-of-pocket expenses
- Instant Savings Card benefit is limited to up to 12 uses annually
- Commercially insured patients could have additional financial responsibility for any amounts over Eisai’s maximum liability
- No substitutions permitted
- Save the Instant Savings Card to reuse with each prescription
- Not valid for prescriptions for DAYVIGO or any other product reimbursed in full by third-party payers
- May not be combined with any other discount or offer
- Federal law prohibits the selling, purchasing, trading, or counterfeiting of this card
- Void outside of the US 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, third-party payers, and applicable law on the redemption
- The value of this card is not contingent on any prior or future purchases
- This card may not be accepted at all pharmacies
- This card is not an insurance program
- No membership fees
- This offer will expire December 31, 2022
DAYVIGO PATIENT ASSISTANCE PROGRAM
The DAYVIGO Patient Assistance Program provides DAYVIGO at no cost to patients in need who meet program eligibility criteria.*DOWNLOAD THE FORM
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 DAYVIGO?
DAYVIGO is a prescription medicine for adults age 18 years and older who have trouble falling or staying asleep (insomnia).
IMPORTANT SAFETY INFORMATION
DAYVIGO may cause serious side effects including:
decreased awareness and alertness. The morning after you take DAYVIGO, your ability to drive safely and think clearly may be decreased. You may also have sleepiness during the day. Do not take more DAYVIGO than prescribed. Do not take DAYVIGO unless you are able to stay in bed for a full night (at least 7 hours) before you must be active again. Take DAYVIGO right before going to bed.
Do not take DAYVIGO if you fall asleep often at unexpected times (narcolepsy).
DAYVIGO is a federally controlled substance because it can be abused or cause dependence.
Before taking DAYVIGO, tell your healthcare provider about all of your medical conditions, including if you:
have a history of depression, mental illness, or suicidal thoughts; drug or alcohol abuse or addiction; a sudden onset of muscle weakness (cataplexy); daytime sleepiness
have lung problems or breathing problems
have liver problems
are pregnant or plan to become pregnant
are breastfeeding or plan to breastfeed. DAYVIGO passes into your breastmilk
Tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter medicines, vitamins and herbal supplements.
Taking DAYVIGO with certain other medicines can cause serious side effects. DAYVIGO may affect the way other medicines work and other medicines may affect the way DAYVIGO works.
Do not take DAYVIGO with other medicines that can make you sleepy unless your healthcare provider tells you to.
What should I avoid while taking DAYVIGO?
Do not drink alcohol while taking DAYVIGO. It can increase your chances of getting serious side effects.
Do not drive, operate heavy machinery, do anything dangerous, or other activities that require clear thinking if you take DAYVIGO and have had less than a full night of sleep (at least 7 hours) or if you have taken more DAYVIGO than prescribed by your healthcare provider.
You may still feel drowsy the next day after taking DAYVIGO. Do not drive or do other dangerous activities until you feel fully awake.
DAYVIGO may cause serious side effects, including:
temporary inability to move or talk (sleep paralysis) for up to several minutes while you are going to sleep or waking up
temporary weakness in your legs that can happen during the day or at night
complex sleep behaviors such as sleep-walking, sleep-driving, preparing and eating food, making phone calls, having sex or doing other activities while not fully awake that you may not remember the next morning.
worsening depression and suicidal thoughts have happened during treatment with DAYVIGO.
The most common side effect of DAYVIGO is sleepiness.
These are not all of the possible side effects of DAYVIGO. Call your doctor for medical advice and if you have any new or worsening side effects.
Please read the accompanying Medication Guide for DAYVIGO and discuss it with your doctor