Restrictions and Conditions of Use

Savings Card

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. For patients with commercial insurance that covers the product, the patient pays the first $30 for BELVIQ XR or $40 for BELVIQ, and then Eisai Inc. will provide no more than $160 off the patient’s out-of-pocket costs per commercially insured, covered prescription. For patients paying cash who have commercial insurance that does not cover the product, Medicare Part D, TRICARE, or are uninsured, Eisai will provide no more than $195 off the patient’s cash price per 30 day fill. Save this card to reuse each month up to the expiration date or program discontinuation. No substitutions permitted.

  • 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, or the Puerto Rico Government Health Insurance Plan, or any similar state or federal healthcare programs.
  • Medicare Part D and TRICARE 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 TRICARE, 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 or TRICARE catastrophic cap.
  • 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.
  • The card is solely intended to provide savings on any purchase of BELVIQ or BELVIQ XR. Use of the card for any single purchase does not obligate the patient to make future purchases of BELVIQ or BELVIQ XR or any other product.
  • Void outside the USA, including US territories and where prohibited by law.
  • This card expires 08/31/2018.
  • 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; such activities may result in imprisonment of 10 years, fines of $250,000, or both.
  • 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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What is BELVIQ®/BELVIQ XR®?

BELVIQ/BELVIQ XR is a FDA-approved prescription weight-loss medication that, when used with diet and exercise, can help some adults (body mass index [BMI]  27 kg/m2) living with extra weight, with a weight-related medical problem, or adults living with obesity (BMI  30 kg/m2), lose weight and keep it off. It is not known if BELVIQ/BELVIQ XR when taken with other prescription, over-the-counter, or herbal weight-loss products is safe and effective. It is not known if BELVIQ/BELVIQ XR changes your risk of heart problems, stroke, or death due to heart problems or stroke.

Important Safety Information

  • Pregnancy: Do not take if you are pregnant or planning to become pregnant, as weight loss offers no benefit during pregnancy and BELVIQ/BELVIQ XR may harm your unborn baby.
  • Hypersensitivity reactions: Do not take if you are allergic to lorcaserin or any of the ingredients in BELVIQ/BELVIQ XR.
  • Serotonin Syndrome or Neuroleptic Malignant Syndrome (NMS)-like reactions: Before using, tell your Healthcare Provider about all the medicines you take, especially medicines that treat depression, migraines, mental problems, or the common cold. These medicines may cause serious or life-threatening side effects if taken with BELVIQ/BELVIQ XR. Call your Healthcare Provider right away if you experience agitation, hallucinations, confusion, or other changes in mental status; coordination problems; uncontrolled muscle spasms; muscle twitching; restlessness; racing or fast heartbeat; high or low blood pressure; sweating; fever; nausea; vomiting; diarrhea; or stiff muscles.
  • Valvular heart disease: Some people taking medicines like BELVIQ/BELVIQ XR have had heart valve problems. Call your Healthcare Provider right away if you experience trouble breathing; swelling of the arms, legs, ankles, or feet; dizziness, fatigue, or weakness that will not go away; or fast or irregular heartbeat. Before taking BELVIQ/BELVIQ XR, tell your Healthcare Provider if you have or have had heart problems.
  • Changes in attention or memory: BELVIQ/BELVIQ XR may slow your thinking. You should not drive a car or operate heavy equipment until you know how BELVIQ/BELVIQ XR affects you.
  • Mental problems: Taking too much BELVIQ/BELVIQ XR may cause hallucinations, a feeling of being high or in a very good mood, or feelings of standing outside your body.
  • Depression or thoughts of suicide: Call your Healthcare Provider right away if you notice any mental changes, especially sudden changes in your mood, behaviors, thoughts, or feelings, or if you have depression or thoughts of suicide.
  • Low blood sugar: Weight loss can cause low blood sugar in people taking medicines for type 2 diabetes, such as insulin or sulfonylureas. Blood sugar levels should be checked before and while taking BELVIQ/BELVIQ XR. Changes to diabetes medication may be needed if low blood sugar develops.
  • Painful erections: If you have an erection lasting more than 4 hours while on, stop taking BELVIQ/BELVIQ XR and call your Healthcare Provider or go to the nearest emergency room right away.
  • Slow heartbeat: BELVIQ/BELVIQ XR may cause your heart to beat slower.
  • Decreases in blood cell count: BELVIQ/BELVIQ XR may cause your red and white blood cell counts to decrease.
  • Increase in prolactin: BELVIQ/BELVIQ XR may increase the amount of a hormone called prolactin. Tell your Healthcare Provider if your breasts begin to make milk or a milky fluid, or if you are a male and your breasts increase in size.
  • Most common side effects of BELVIQ®/BELVIQ XR®: Headache, dizziness, fatigue, nausea, dry mouth, constipation, cough, low blood sugar (hypoglycemia) in patients with diabetes, and back pain.
  • Nursing: BELVIQ/BELVIQ XR should not be taken while breastfeeding.
  • Drug interactions: Before taking BELVIQ/BELVIQ XR, tell your Healthcare Provider if you take medicines for depression, migraines, or other medical conditions, such as: triptans; medicines used to treat mood, anxiety, psychotic or thought disorders, including tricyclics, lithium, selective serotonin reuptake inhibitors, selective serotonin-norepinephrine reuptake inhibitors, monoamine oxidase inhibitors, or antipsychotics; cabergoline; linezolid (an antibiotic); tramadol; dextromethorphan (an over-the-counter (OTC) common cold/cough medicine); OTC supplements such as tryptophan or St. John’s Wort; or erectile dysfunction medicines.

BELVIQ®/BELVIQ XR® is a federally controlled substance (CIV) because it may be abused or lead to drug dependence.
For more information about BELVIQ®/BELVIQ XR® talk to your Healthcare Provider and see the full Product Information.
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.