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HCP Site
Eisai Patient Support (EPS) provides
information and
resources to help
patients afford the cost of LEQEMBI.
Eisai Patient Support (EPS) provides
information and
resources to help
patients afford the cost of LEQEMBI.
Click on any section at any time to navigate there
EPS provides information and resources to help you get access to LEQEMBI® (lecanemab-irmb)
(scroll down to the next section for more on what Patient Navigators do).
Patients who enroll in EPS
will have a dedicated
Patient Navigator
EPS offers assistance and information for patients taking LEQEMBI, including:
Check for
coverage
Prior authorization
information
Appeal
information
Financial Assistance Program information
To find out more information and eligibility requirements for these programs, see below.
The LEQEMBI Copay Assistance Program is sponsored by Eisai. This program
is available to help eligible commercially insured patients with their
medication cost.
Patients with a state or federally funded insurance, such as
Medicare Part B
or Medicaid, are not eligible for the program.
Copay Assistance Program terms and conditions
Patient must be prescribed LEQEMBI for an FDA-approved indication. Patient
must have private, commercial health insurance that provides coverage for
LEQEMBI. The offer is not valid for patients enrolled in state and federal
healthcare programs, including Medicare, Medicaid, Medigap, VA, DOD, or
TRICARE, that cover outpatient care, including for physician-administered or
prescription drugs, or otherwise cover LEQEMBI. The offer is not valid for
uninsured or self-paying patients, or for LEQEMBI treatments reimbursed in
full by any third-party payer. Patient must be 18 years or older. Patient must
be a resident of, and product must be administered in, the United States or
Puerto Rico.
The benefit available under the LEQEMBI Copay Assistance Program is limited
to patient's out-of-pocket cost for LEQEMBI, as indicated in documentation
provided by the patient's health insurance provider, including a CMS-1500 or
UB-04 Form AND an insurance explanation of benefits (EOB) with itemized
charges which include the billing code for LEQEMBI. Eligible patients who
participate in the Program may pay as little as $0 out-of-pocket per date of
treatment. Eisai Inc. will pay up to $10,000 per calendar year toward an
eligible patient's out-of-pocket costs for LEQEMBI, including deductibles,
copays and coinsurances. Depending on the patient's insurance plan, patient
could have additional financial liability for any amounts over Eisai's maximum
benefit. The offer is not valid for any other out-of-pocket costs, including
medical administration charges. Supporting documentation must be
submitted to the LEQEMBI Copay Assistance Program within 365 days of the
date of treatment or the request will be rejected. In order to be eligible for
reimbursement under LEQEMBI Copay Assistance Program, claims for
LEQEMBI must be submitted by provider to patient's private health insurance
separately from other services and products. Additional instructions regarding
required documentation in support of each claim will be provided by the
program following confirmation of eligibility and enrollment. The LEQEMBI
Copay Assistance Program will process eligible claims for patient out-of-
pocket costs for LEQEMBI incurred for product administered up to 180 days
prior to the date the patient is enrolled in the program.
Upon enrollment in the program, each patient will be issued a 16-digit virtual
debit card. By enrolling in this program, the patient is providing consent for
the LEQEMBI Copay Assistance Program to provide payment information for
any approved claims, in the form of the 16-digit virtual debit card number,
directly to the provider or alternate site of care identified on this enrollment
form to be applied directly to the patient's out-of-pocket costs for LEQEMBI.
By enrolling in the program and accepting payment, provider agrees to put
the value of the patient LEQEMBI Copay Assistance Program directly toward
the patient's out-of-pocket costs for LEQEMBI only. If provider has already
received payment from the patient for the patient's out-of-pocket cost for
LEQEMBI covered by the program, provider agrees to refund the amounts
received back to the patient.
Patient and provider agree not to seek reimbursement for any or all of the
benefit received by the patient through the LEQEMBI Copay Assistance
Program. Patients and providers are responsible for complying with all
requirements to disclose to insurance carriers and third-party payers the
benefit received from the LEQEMBI Copay Assistance Program. The offer may
not be combined with any other discount, coupon, free trial or offer. Federal
law prohibits the selling, purchasing, trading, or counterfeiting of this offer.
Void outside the USA and where prohibited by law. Eisai Inc. reserves the right
to rescind, revoke, or amend this offer at any time without notice. The value
of this offer is not contingent on any prior or future purchases. This offer is
solely intended to provide savings on the purchase of LEQEMBI. This offer
may not be accepted by all providers or alternate sites of care. The LEQEMBI
Copay Assistance Program is not an insurance program. No membership fees.
The Temporary Supply Program (“TSP”) provides a temporary free supply of
up to 75 days of LEQEMBI for eligible, commercially insured patients awaiting
a coverage determination from their insurance provider for five or more
business days.
Temporary Supply Program terms and conditions
Patient must have a valid prescription for LEQEMBI for an FDA-approved
indication. Patient must have private, commercial insurance that provides
coverage for drugs through a medical benefit. The TSP is not available for
uninsured patients or patients enrolled in state and federal healthcare
programs, including Medicare, Medicaid, Medigap, VA, DoD, or TRICARE.
Patient must be 18 years or older. Patient must be a resident of, and product
must be administered in, the United States or Puerto Rico. Patient must meet
the financial eligibility criteria for enrollment in the Patient Assistance Program
for LEQEMBI in order to be eligible for the TSP.
In order to be eligible for the TSP, the patient must be new to LEQEMBI therapy
and must be awaiting a final coverage determination from their insurance
provider for five or more business days and the patient’s provider has
submitted a first-level appeal of the prior authorization denial. If an enrolled
patient’s appeal is subsequently approved, patient will no longer be
eligible to receive temporary supply of LEQEMBI. In order for patient to
continue to be eligible for the TSP, the patient’s provider must agree to
appropriately pursue insurance coverage for the patient until a final coverage
determination is made. Limit of one enrollment (up to 75-day supply while
coverage is pending) per patient per lifetime. The TSP will ship each treatment of
LEQEMBI directly to the provider or alternate site of care identified on this
enrollment form. Enrolled patients will be evaluated for continued TSP eligibility
prior to each shipment. By accepting shipment, provider agrees to administer the
temporary supply of LEQEMBI only to the enrolled patient named in the materials
accompanying the shipment and to discard unused amounts in open vials.
Provider further agrees that LEQEMBI provided under the TSP may not be sold,
traded, bartered, transferred, or returned for credit. LEQEMBI provided under
the TSP must be maintained separately from commercial inventory.
If the enrolled patient is no longer on therapy or otherwise cannot use the
temporary supply of LEQEMBI, provider agrees to promptly contact
Eisai Patient Support to arrange for product return or disposal.
No patient, pharmacy, payor or other third-party may be billed for the
temporary supply of LEQEMBI. Patients and providers must not submit any
claim for reimbursement for product dispensed pursuant to the TSP to any
third-party payor, including Medicare, Medicaid, or any other federal or state
health care program. Patient cannot seek to have any part of the value of the
free product received through the TSP count towards any applicable out-of-pocket
spending calculations for drugs (eg, deductible or out-of-pocket cap).
The free LEQEMBI provided under the TSP is not contingent on any past or
future purchases of any product, under the patient’s insurance benefit or
otherwise. Eligibility determinations are made without regard to patient’s
commercial insurance provider, choice of physician or infusion provider.
Patients are free to change physicians or infusion providers at any time. The
TSP is not a health insurance, financial support, or cost savings program.
Limitations may apply. Eisai reserves the right to rescind, revoke, or amend
the TSP at any time without notice. Additional terms and conditions and
eligibility criteria apply. Contact the Eisai Patient Support Program for
additional information.
The LEQEMBI Patient Assistance Program is for patients who need help
paying for LEQEMBI. This program provides LEQEMBI at no cost to uninsured
and financially burdened patients who meet the program eligibility criteria.
Patient Assistance Program terms and conditions
The Patient Assistance Program (''Program'') provides free drug for eligible
patients who meet financial need and insurance coverage criteria. Patients
must have a valid prescription for LEQEMBI for an FDA-approved indication.
Patient must be either uninsured or insured but without insurance coverage
for LEQEMBI (ie, the insurer must have denied a first-level appeal of an initial
coverage denial) or without enough coverage to pay for LEQEMBI. Patient
must have a household income equal to or less than 500 percent of the
Federal Poverty Level. Patient must be 18 years or older. Patient must be a
resident of, and product must be administered in, the United States or Puerto
Rico. Commercially insured patients and Federal health care program
beneficiaries who qualify for the Program are enrolled for the entire calendar
year. Uninsured patients who qualify for the Program are enrolled for a rolling
12-month period. During the Program enrollment period, patients must receive
all LEQEMBI doses through the Program only. Patients cannot be administered
commercial units of LEQEMBI, and neither patients nor providers may submit
claims for commercial units of LEQEMBI, during the Program enrollment period.
All patients must re-enroll at the end of their respective Program approval
period to ensure they continue to meet the Program's eligibility criteria.
Eisai reserves the right to reassess eligibility for patients with commercial
insurance during the enrollment period.
The Program will ship each dose of LEQEMBI directly to the provider or
infusion center identified in patient’s enrollment form. Quantities of Product
shipped are limited to the number of vials the prescribing physician confirmed
in writing are needed and clinically appropriate for the designated patient
for a one-month supply of the Product. By accepting shipment, provider
agrees to administer the free supply of LEQEMBI only to the enrolled patient
and to discard unused amounts in open vials. Product provided through the
Program may not be sold, traded, bartered, transferred, or returned for credit.
LEQEMBI provided under this Program must be maintained separately from
commercial inventory. If the enrolled patient is no longer on therapy or
otherwise cannot use the free supply of LEQEMBI, provider agrees to
promptly contact the Eisai Patient Support Program to arrange for product
return or destruction. If provider fails to meet any Program requirements,
the Program will cease sending any additional Program product to the
provider until the provider comes into compliance.
No patient, pharmacy, payor, or other third-party may be billed for the free
drug provided pursuant to the Program. Patients and providers must not
submit any claim for reimbursement for product pursuant to this Program to
any third-party payor, including Medicare, Medicaid, or any other federal or
state health care program. Patient cannot apply the value of the free product
received through this Program toward any insurance benefit out-of-pocket
spending calculations such as Medicare Part D True Out-of-Pocket Costs
(TrOOP). The free LEQEMBI provided under the Program is not contingent on
any past or future purchases of any product, under the patient's insurance
benefit or otherwise. Eligibility determinations are made without regard to
patient's insurance provider (if any), choice of physician or infusion provider.
Patients are free to change physicians or infusion providers at any time. The
Program is not health insurance. Limitations may apply. Eisai reserves the
right to rescind, revoke, or amend this Program at any time without notice.
Additional terms and eligibility criteria apply. Contact the Eisai Patient Support
Program for additional information.
Patient Navigators serve as a single point of contact within EPS
to support patients and care partners throughout your treatment with LEQEMBI.
Call 1-833-4-LEQEMBI to speak
to a Patient Navigator today
Patient Navigators may help patients and their care partners in the following ways:
Enrolling in EPS is simple, but requires both patients and
healthcare providers to participate. Speak to your doctor about
enrolling in EPS during one of your visits.
Step 1:
Your doctor will select program offerings for which you will be evaluated and fill in
additional information required by them.
They will ask you to complete all patient sections of the form, including required signatures
for the programs selected. Your doctor may assist you in completing your portion of the form.
You may complete the enrollment form in person with your doctor, or you may
enroll digitally by visiting LEQEMBIConsent.com
If you or your doctor need additional assistance with enrollment, you may call EPS at
1-833-453-7362 to speak with a Patient Navigator.
Step 2:
Your doctor will fax the completed enrollment form to EPS at 1-833-770-7017.
What happens after my doctor and I enroll?
Once all required information and signatures are provided by you and your doctor, EPS will
reach out to you with next steps and to welcome you to the program.
Here, you’ll find some answers to Frequently Asked Questions (FAQs)
from patients like you
Click the + sign by the
question to see the answer,
and click the – sign to close
the question after you’re
done reading
The best way to determine your coverage is to talk to your insurance carrier or your physician, or call EPS at the phone number at the top of the page to speak to a Patient Navigator. Below, you can read some basic information about different types of insurance.
Types of insurance
Commercial insuranceCommercial 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. Some insurance plans may provide coverage for LEQEMBI. Commercially insured patients may be eligible for the LEQEMBI Copay Assistance Program.
MedicareMedicare 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 infusions, such as LEQEMBI. On July 6, 2023, the Centers for Medicare and Medicaid Services (CMS) released information regarding coverage for prescription medicines used to treat Alzheimer’s disease (AD) for Medicare patients. For more information click here.
MedicaidMedicaid 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.
Download Health Insurance BrochureIf you received the “Prior authorization required” categorization, then it means that prior authorization is required for your physician to obtain approval from your health insurance plan prior to prescribing LEQEMBI. Speak to your healthcare provider to address any prior authorization requirements.
If you called your insurance company and were told that LEQEMBI is not covered under your plan, or if you tried to fill a prescription for LEQEMBI 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.
For information regarding local infusion sites of care in your area, you may call Eisai Patient Support at
1-833-453-7362.
Download the following helpful patient materials:
LEQEMBI.com can provide additional information about LEQEMBI, including:
LEQEMBI Companion™ can help patients pass time during their infusion appointments.
Visit the LEQEMBI patient siteThe following patient advocacy organizations might provide additional information or assistance, including educational tools, counseling, and support groups.*
*The organizations listed are independent from Eisai. Eisai does not influence or control the operations or eligibility criteria for these independent programs. This information is provided for informational purposes only.
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.
LEQEMBI is a prescription
medicine used to treat people with Alzheimer’s disease.
LEQEMBI is a prescription medicine used to treat people with early Alzheimer’s disease, which includes mild cognitive impairment (MCI) or mild dementia stage of disease.
What is the most important information I should know about LEQEMBI?
LEQEMBI can cause serious side effects,
including:
ARIA (Amyloid-Related Imaging Abnormalities). ARIA is a side effect that does not usually cause any symptoms, but serious symptoms can occur. ARIA can be fatal.
ARIA commonly shows up as temporary swelling in areas of the brain that usually goes away over time
Small spots of bleeding in or on the surface of the brain can occur
Less often, larger areas of bleeding in the brain can occur
Most people with ARIA don’t have any
symptoms.
However, some people
may notice:
– headache
– confusion that
gets worse
– dizziness
– vision changes
– nausea
– difficulty walking
– seizures
Some people have a gene called ApoE4 that may increase the risk of ARIA. Talk to your healthcare provider
about testing to see if you have
this gene
You may be at a higher risk of developing bleeding in the brain if you take medicines to reduce blood clots from forming (antithrombotic medicines) while receiving LEQEMBI. Talk to your healthcare provider to see if any of the medicines you’re taking increase this risk
Your healthcare provider will check for ARIA with MRI (magnetic resonance imaging) scans before you start LEQEMBI and
during treatment
You should carry information that says you are receiving LEQEMBI, which can cause ARIA, and that ARIA symptoms can look like stroke symptoms
Call your healthcare
provider or go to the nearest hospital emergency room
right away if you have any of the symptoms listed above.
Serious allergic reactions:
Do not receive LEQEMBI if you have serious allergic reactions to LEQEMBI or any of the ingredients in LEQEMBI.
Tell your healthcare provider if you notice any symptoms during or after a LEQEMBI infusion, including:
– swelling of the face, lips, mouth, or tongue
– itchy bumps on the skin, also known as hives
– difficulty breathing
Infusion-related reactions:
Tell your healthcare provider right away if you notice any of these symptoms during a LEQEMBI infusion:
– fever
– flu-like symptoms (chills, body aches, feeling shaky, joint pain)
– nausea and/or vomiting
– dizziness or lightheadedness
– fast or slow heart rate, or feeling like your chest is pounding
– difficulty breathing or shortness of breath
If you have an infusion-related reaction, your healthcare provider may give you medicines before your next infusion to lower the chance of having a reaction
The most common side effects of LEQEMBI include infusion-related reactions, ARIA, and headaches.
These are not all the possible side effects of LEQEMBI. Call your doctor for more information and medical advice about side effects. You may report side effects to the FDA at www.fda.gov/medwatch or call 1-800-FDA-1088.
Before receiving LEQEMBI, tell your healthcare provider about:
All your medical conditions, including if you are pregnant, breastfeeding, or plan to become pregnant or breastfeed. It is not known if LEQEMBI could harm your unborn or breastfeeding baby
All the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Especially tell your healthcare provider if you take medicines to reduce blood clots from forming (antithrombotic medicines, including aspirin)
Please read the full Prescribing Information including Boxed WARNING, and Medication Guide for LEQEMBI.
