Eisai Assistance Program
The Eisai Assistance Program offers access and reimbursement support, including:
Benefits verification Prior authorization information Appeal information Financial assistance information via the HALAVEN® (eribulin mesylate) $0 Co-Pay Program
(see below for more information) The HALAVEN Patient Assistance Program for patients who need help paying for HALAVEN. This program
provides HALAVEN at no cost to uninsured and financially burdened patients who meet the program
Prior authorization information
Financial assistance information via the HALAVEN® (eribulin mesylate) $0 Co-Pay Program (see below for more information)
The HALAVEN Patient Assistance Program for patients who need help paying for HALAVEN. This program provides HALAVEN at no cost to uninsured and financially burdened patients who meet the program eligibility criteria
HALAVEN® $0 CO-PAY PROGRAM
With the HALAVEN $0 Co-Pay Program, you could pay as little as $0 out of pocket for each prescription.
Eisai will pay up to $18,000 per year to assist with the out-of-pocket costs for HALAVEN. Depending on your insurance plan, you could have additional financial responsibility for any amounts over Eisai’s maximum liability.
ELIGIBILITY CRITERIA & TERMS AND CONDITIONS
Not available to patients enrolled in state or federal healthcare programs, including Medicare, Medicaid, Medigap, VA, DoD, or TRICARE
Offer only available to patients with private, commercial insurance
Program is not valid for cash-paying customers
TERMS AND CONDITIONS
Good toward the purchase of HALAVEN prescriptions
No substitutions permitted
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 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 on third-party payers
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 August 31, 2023
HALAVEN® Patient Assistance Program
The HALAVEN Patient Assistance Program provides HALAVEN at no cost to patients in need who meet program eligibility criteria.*
To determine if you are eligible, download the HALAVEN Eisai Assistance Program Enrollment Form or call 1-866-61-EISAI (1-866-613-4724)1-866-61-EISAI (1-866-613-4724). Hours of operation are Monday through Friday, 8 AM to 8 PM ET.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.
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.