What is Eisai Patient Support?

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).

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Patients who enroll in EPS
will have a dedicated
Patient Navigator

EPS offers assistance and information for patients taking LEQEMBI, including:

Check for coverage icon

Check for
coverage

Prior authorization icon

Prior authorization
information

Appeal information icon

Appeal
information

Financial assistance program icon

Financial Assistance Program information

To find out more information and eligibility requirements for these programs, see below.

Full terms and conditions

  • LEQEMBI Copay
    Assistance Program

    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.

  • LEQEMBI Temporary
    Supply Program

    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 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.

  • LEQEMBI Patient
    Assistance Program

    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 two administrations 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.

What are Patient Navigators?

Patient Navigators serve as a single point of contact within EPS
to support patients and care partners throughout your treatment with LEQEMBI.

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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:

  • Understand insurance coverage
  • Identify financial support programs for eligible patients
  • Find an infusion site of care should you or your HCP need assistance finding one
  • Know what to expect at each step of the treatment journey

How do I enroll in Eisai Patient Support?

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.

Where can I
find more
information?

Here, you’ll find some answers to Frequently Asked Questions (FAQs)
from patients like you

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Click the + sign by the
question to see the answer,
and click the – sign to close
the question after you’re
done reading

  • Will my insurance
    cover LEQEMBI?

    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 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. Some insurance plans may provide coverage for LEQEMBI. Commercially insured patients may be eligible for the LEQEMBI Copay Assistance Program.

    Medicare

    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 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.

    Medicaid

    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.

    Download Health Insurance Brochure
  • What can I do if I receive
    a denial of coverage?

    If 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.

  • Where can I receive my
    LEQEMBI infusion?

    For information regarding local infusion sites of care in your area, you may call Eisai Patient Support at
    1-833-453-7362.

  • Where can I find more information
    on LEQEMBI and
    Alzheimer’s disease?

    Download the following helpful patient materials:

    LEQEMBI.com can provide additional information about LEQEMBI, including:

    • How LEQEMBI works
    • Side effects of LEQEMBI
    • Safety information for LEQEMBI
    • Infusion tips for LEQEMBI

    LEQEMBI Companion™ can help patients pass time during their infusion appointments.

    Visit the LEQEMBI patient site
  • Are there any other patient
    organizations for
    Alzheimer’s disease?

    The 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.

IMPORTANT SAFETY INFORMATION

WHAT IS LEQEMBI?

LEQEMBI is a prescription
medicine used to treat people with Alzheimer’s disease.

EXPAND COLLAPSE

WHAT IS LEQEMBI?

LEQEMBI is a prescription
medicine used to treat people with Alzheimer’s disease.

If you have serious allergic reactions to any of the ingredients in LEQEMBI, you should not be treated with LEQEMBI.

IMPORTANT SAFETY
INFORMATION

What is the most important information I should know about LEQEMBI?

LEQEMBI can cause serious side effects, including:

  • ARIA (amyloid-related imaging abnormalities). There are usually no signs of ARIA. In rare cases,
    it can lead to serious complications

  • ARIA can show up as swelling in parts of the
    brain or small spots of bleeding

  • Larger areas of bleeding in the brain may occur, but this
    is uncommon

  • ARIA usually goes away
    over time

  • Most people with ARIA don’t have any
    symptoms. However, some people
    may notice:

    headache

    confusion that
    gets worse

    dizziness

    vision problems

    nausea

    problems 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

  • Some medicines can increase the risk of larger areas of bleeding in the brain for people taking 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

Call your healthcare
provider or go to the nearest hospital emergency room
right away if you have any of the symptoms listed above.

Before receiving LEQEMBI, tell your healthcare provider about all your medical conditions, including
if you:

  • are pregnant or plan to become pregnant. It is not known if LEQEMBI will harm your unborn baby. Tell your healthcare provider if you become pregnant during your treatment
    with LEQEMBI

  • are breastfeeding or plan to
    breastfeed. It is not known if any of the ingredients in LEQEMBI pass into your breast milk. Talk to your healthcare provider about the best way to feed your baby while
    receiving LEQEMBI

Tell your healthcare provider about 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 (including aspirin). Ask your healthcare provider for a list of these medicines if you are
not sure.

Keep a list of the medicines you take. Show it to your healthcare provider and pharmacist when you get a new medicine.

What are the possible
side effects of LEQEMBI?

LEQEMBI can cause serious side effects, including:

  • ARIA (amyloid-related imaging abnormalities) (see above)

  • Serious allergic reactions may happen during a LEQEMBI infusion. Tell your healthcare provider if you notice any of these symptoms during or after a
    LEQEMBI infusion:

    swelling of the face, lips, mouth, or tongue

    itchy bumps on the skin, also known as hives

    difficulty breathing

  • Infusion-related reactions are common and can sometimes be serious. Tell your healthcare provider right away if you notice any of these symptoms during
    an infusion:

    fever

    flu-like symptoms (chills, joint and body aches, feeling shaky)

    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

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

  • swelling in areas of the brain, with or without small spots of bleeding in or on the surface of the
    brain (ARIA)

  • headache

These are not all the possible side effects of LEQEMBI. Call your doctor for more information and medical advice about side effects. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch
or call 1-800-FDA-1088.

Please read the Prescribing Information including Boxed WARNING, and Medication Guide for LEQEMBI.

WHAT IS LEQEMBI?

LEQEMBI is a prescription
medicine used to treat people with Alzheimer’s disease.

If you have serious allergic reactions to any of the ingredients in LEQEMBI, you should not be treated with LEQEMBI.