Request your savings card

Eligibility

Please fill in your insurance details first to determine your eligibility for the savings card offer.

What type of insurance coverage do you have?

*Required fields.

*Are you 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 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. Do you understand and agree with these terms?

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.
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.

Registration

Now, please fill in your personal demographic information to activate/register the savings card.

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Date of Birth
Please note: You must be at least 18 years of age.
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You must be 18 years of age.
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Terms of Information Use
Eisai's Terms of Information Use.
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Government Prescription Benefits

If you start receiving prescription benefits from a federal, state, or government funded program at any time, your savings card will no longer be valid, and you may no longer use your savings card. Although Medicare Part D patients are eligible to participate in the savings card, they are subject to different terms and conditions, so you must re-enroll and obtain a new savings card if you enroll in Medicare Part D. Do you understand and agree with these terms?

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REQUEST MY CARD >

Please be advised that the personal information you provide will be used to satisfy your request to receive or activate a savings card. The marketer of BELVIQ® and BELVIQ XR®, Eisai Inc. (“Eisai” or “we”), operates this website and our Privacy Policy will govern the collection, use, disclosure and retention of the information you provide here. This includes information obtained about your use of the card, which will be shared with Eisai and our service providers. Please do not submit any personal information unless you have read and agree with the terms of that Privacy Policy. Consistent with the Privacy Policy, we and our service providers may use the personal information you provide to contact you and send you communications about BELVIQ/BELVIQ XR®. At any time, you may request to be removed from the email communication list to receive such communications by contacting Eisai Corporate Communications at: ESICorporate_Communications@eisai.com. By clicking the checkbox below, you agree that you have read, understand, and agree to these conditions.