Have questions about your insurance coverage?
HALAVEN® (eribulin mesylate) 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 HALAVEN.
Types of Insurance
Commercial 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 HALAVEN. Contact your pharmacist or insurance company to find out if you will have coverage for HALAVEN.
Commercially insured patients may be eligible for the HALAVEN $0 Co-Pay Program.
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 B covers doctor's office visits and visits to treatment centers for injections, such as HALAVEN. Your healthcare provider will be able to help you understand how Medicare may cover HALAVEN.
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. However, coverage and patient out-of-pocket costs vary from state to state. Your healthcare provider will be able to help you understand how your state Medicaid plan may cover HALAVEN.
Insurance plans are not affiliated with or offered by Eisai.
DETERMINING YOUR COVERAGE
If you are planning to see your doctor to determine if HALAVEN is right for you, or if you have recently received a prescription for HALAVEN, you may want to investigate your health insurance coverage for this type of drug prior to your visit.
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 HALAVEN?
- Are there any cancer treatments I’m required to have tried prior to authorizing coverage of HALAVEN?
- 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 HALAVEN. 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 cancer therapy before approving coverage for HALAVEN. 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 HALAVEN is not covered under your plan, or if you tried to fill a prescription for HALAVEN 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.
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
HALAVEN® is available by prescription only.