The Savings Card must be activated online or by telephone before it may be used. To activate the Savings Card, individuals must answer several questions to determine if they are eligible to participate in the Savings Card and, if an individual uses Medicare Part D for prescription drug coverage, the individual must agree that he or she (1) will not submit claims for the Drug to their Medicare Part D plan and (2) will not apply any amounts paid by an individual when using the Savings Card towards Medicare Part D true out-of-pocket (TrOOP) expenses. Eisai Inc. has entered into an agreement with McKesson to implement the Savings Card. McKesson processes pharmacy claims and relies on claims data to detect, in real time, attempted Savings Card use by individuals who are ineligible to participate in the Savings Card offer.
To the Patient
You must activate this card and present it to the pharmacist along with your prescription to participate in this program. If you have any questions regarding your eligibility or benefits, call 1-855-BELVIQ1 (1-855-235-8471), 8:00 am-11:00 pm EST, Monday-Friday. When you use this card, you are certifying that you understand and will comply with the program rules, regulations, and terms and conditions. You are eligible for copayment assistance using this Savings Card if your commercial insurance covers BELVIQ or BELVIQ XR. You are eligible for cost savings if you pay cash for BELVIQ or BELVIQ XR and have commercial insurance or Medicare Part D, that does not cover BELVIQ or BELVIQ XR or are uninsured. You are not eligible for this Savings Card if you are eligible for any other state or federal healthcare programs that cover prescription drugs, including but not limited to Medicaid, CHAMPVA, the Department of Veterans Affairs healthcare program, TRICARE, or the Puerto Rico Government Health Insurance Plan, or where prohibited by law; and you will otherwise comply with the terms above.
Medicare Part D patients without coverage for BELVIQ® or BELVIQ XR® may use this card if paying the full cash price for a prescription covered by this card and no claim is submitted to Medicare or any other federal, state, or other governmental program. Out-of-pocket expenses incurred using this card cannot be applied towards Medicare Part D true out-of-pocket (TrOOP) expenses.
To the Pharmacist
When you use this card, you are certifying that the patient is eligible for the Savings Card and you have not submitted and will not submit a claim for reimbursement under any state or federal healthcare programs for this prescription.
- The Savings Card is not valid unless activated online or by phone.
- Submit transaction to McKesson Corporation using BIN #610524.
- If primary coverage (other than Medicare Part D) exists, input card information as secondary coverage and transmit using the COB segment of the NCPDP transaction. If no coverage exists or if patient has Medicare Part D, input card information as primary coverage and no secondary coverage information should be entered.
- Acceptance of this card and your submission of claims for the savings card program for BELVIQ® (lorcaserin HCl) CIV and BELVIQ XR® (lorcaserin HCl) CIV are subject to the LoyaltyScript® program Terms and Conditions posted at mckesson.com/mprstnc.
- Patient is not eligible if prescriptions are paid in part or full by any state or federal healthcare programs, including, but not limited to Medicare, Medicaid, MediGap, VA, TRICARE, or DOD, and where prohibited by law. Note that patients with Medicare Part D are eligible as cash paying patients because BELVIQ® and BELVIQ XR® are subject to a coverage exclusion under those plans.
- For questions regarding setup, claim transmission, patient eligibility or other issues, call the LoyaltyScript® program for BELVIQ® at 1-800-657-7613, 8:00 am-8:00 pm EST, Monday-Friday.
- For complete Restrictions and Conditions of Use go to: https://www.belviq.com/patient/restrictions-and-conditions