Dosage & Administration Drug label Prior authorization Financial assistance

Horizant

(gabapentin)

gabapentin enacarbil 300 MG Extended Release Oral Tablet [Horizant]gabapentin enacarbil 600 MG Extended Release Oral Tablet [Horizant]

NO BLACK BOX WARNING

Dosage & administration

Instruct patients to swallow tablets whole and not to cut, crush, or chew tablets. Take with food.

RLS: 600 mg once daily taken at about 5 PM.

* A dose of 1,200 mg once daily provided no additional benefit compared with the 600-mg dose, but caused an increase in adverse reactions.
* If the dose is not taken at the recommended time, the next dose should be taken the following day as prescribed.

PHN: The starting dose is 600 mg in the morning for 3 days, then increase to 600 mg twice daily beginning on day 4.

* A daily dose greater than 1,200 mg provided no additional benefit.
* If the dose is not taken at the recommended time, skip this dose, and the next dose should be taken at the time of next scheduled dose.

Patients with renal impairment: Doses of HORIZANT must be adjusted in accordance with renal function.

Horizant prescribing information

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prior authorization

Horizant Prior authorization resources

NOT PROVIDED BY BRANDComplete Letter of Medical Necessity

NOT PROVIDED BY BRANDCoverage Authorization Request

NOT PROVIDED BY BRANDCoverage Authorization Appeals

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Benefits investigation

NOT PROVIDED BY BRANDBenefits investigation resources

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Reimbursement help (FRM)

NOT PROVIDED BY BRANDReimbursement help (FRM) resources

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financial assistance

Horizant Financial assistance options

Co-pay savings program

commercial only

Enroll in Patient Savings Program

Activate Copay Card ( If already have one)

Replace Copay Card

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Overview

Reduce patient OOP costs for drug (and occasionally for drug administration/infusion costs or drug-related test costs)

Patient benefit

A portion (or all) of patient OOP (deductible, copay), typically up to monthly and/or annual max

Patient eligibility

Patient must enroll or activate (may permit HCPs to enroll on patient’s behalf for HCP-administered drugs)
Generally, must have commercial insurance (rarely, may permit uninsured patients to use)
May never be used with government insurance

How to sign up

Cards may be downloadable digital cards or hard copies
Some pharmacos offer debit cards with pre-loaded copay benefit
Typically, available through multiple channels (e.g., rep to HCP to patient; pharmacy to patient; patient via website, Hub live agent, or copay vendor (live agent or IVR); patient and HCP via Hub enrollment form)
Some HCP-administered product programs permit HCPs to enroll on a patient’s behalf through via Hub form

Bridge program

commercial only

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Overview

Provide patient immediate access to therapy during an insurance delay (typically new starts; some may cover change in insurance)
Limited time/ fill (typically 7-30 days; some may offer additional fill for continued delay up to certain limit)

Patient benefit

100% free (outside of insurance)

Patient eligibility

HCP must enroll patient
May be limited to commercially insured patients (i.e., no government beneficiaries); some programs may allow government beneficiaries

How to sign up

Typically HCP assisted enrollment (via form)

Foundation programs

under insured

no insurance

goverment insurance

65+

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Overview

Charitable 501(c)(3) organizations provide direct cost-sharing and other support (e.g., travel, counseling) through disease-state funds to indigent patients on first-come first-served basis
These organizations may receive financial contributions from drug manaufacturers for particular disease-state funds that cannot provide funds directly to patients - the foundation must be independent/unaligned

Patient benefit

Patients apply for grants that cover a portion (or all) of their out-of-pocket costs (deductibles and co-pays) until the grant is exhausted

Patient eligibility

Patients must apply and meet eligibility criteria including income level (typically a multiple of federal poverty line), specific diagnosis, insurance status, etc.

How to sign up

Patients submit proof of out-of-pocket drug costs to charities for reimbursement

patient education

Horizant Patient education

Getting started on Horizant

NOT PROVIDED BY BRANDInstructions For Use - Restless Leg Syndrome (RLS)

NOT PROVIDED BY BRANDInstructions For Use - Postherpetic Neuralgia (PHN)

Patient toolkit

About Horizant - Postherpetic Neuralgia (PHN)

ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

About Horizant - Restless Leg Syndrome (RLS)

ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

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Horizant FAQs

FAQ Data Source

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Please note:

Access to a Field Reimbursement Manager (FRM) or Medical Science Liaison (MSL) varies by brand and may require talking with your rep first.
Samples are provided at the discretion of the brand.
We are unable to collect Protected Health Information (PHI), fill out forms, or submit them on your behalf.

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Dosage & administration

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prior authorization

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Reimbursement help (FRM)

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Horizant Financial assistance options

Co-pay savings program

Overview

Patient benefit

Patient eligibility

How to sign up

Bridge program

Overview

Patient benefit

Patient eligibility

How to sign up

Foundation programs

Overview

Patient benefit

Patient eligibility

How to sign up

patient education

Horizant Patient education

Getting started on Horizant

Patient toolkit

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