• For patients with commercial insurance that covers the product, the patient pays the first $40, and then Eisai will provide no more than $160 off the patient’s out-of-pocket costs per commercially insured covered prescription. Patient could have additional costs based on coverage. For patients paying cash who have commercial insurance that does not cover the product, Medicare Part D, or are uninsured, Eisai will provide no more than $195 off the patient’s cash price per 30 day fill.
  • Good toward the purchase of prescriptions for BELVIQ® (lorcaserin HCI) CIV or BELVIQ XR® (lorcaserin HCI) CIV for up to 13 uses per year. Limited to 1 prescription per patient for any 30-day period. Must be 18 years of age or older.
  • Not available to individuals eligible for federal healthcare programs that may cover prescription drugs, including Medicaid, CHAMPVA, the Department of Veterans Affairs healthcare program, TRICARE, or the Puerto Rico Government Health Insurance Plan, or any similar state or federal healthcare programs.
  • Medicare Part D patients whose insurance does NOT cover 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.
  • Not valid for prescriptions for BELVIQ or BELVIQ XR reimbursed in full by any third-party payer.
  • 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, third-party payers, or applicable law.
  • May not be combined with any other coupon, discount, prescription savings card, free trial, or other offer.
  • The value of this card is not contingent on any prior or future purchases.
  • Void outside the USA, including US territories and where prohibited by law.
  • This card expires 12/31/2020.
  • Offer available to MA residents through July 1, 2019.
  • This card is not an insurance program.
  • This card may not be accepted at all pharmacies.
  • Federal law prohibits the selling, purchasing, trading, or counterfeiting of this savings card.
  • Eisai Inc. reserves the right to rescind, revoke, or amend this offer without notice at any time.
  • Other restrictions apply.

If you have any questions about the program rules or require additional information, please call 1-855-BELVIQ1 (1-855-235-8471).

Financial assistance is available. For more about our Patient Assistance Program for those in financial need, click here.

 

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