Leqembi Copay Assistance Program

Funded

About

The Leqembi Copay Assistance Program offers significant financial aid by reducing out-of-pocket costs for the drug Leqembi. This program ensures that eligible patients may pay as little as $0 per treatment session by covering up to $10,000 annually, making Leqembi more accessible to those in need.

Insurance requirements: Commercially insured

Enrollment Forms

Enrollment Form

Benefits

•$10000 annual maximum benefit

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Must be 18 years of age or older

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: No

•Activation Required: No

Program Details

•Eligible patients may pay as little as $0 outofpocket per date of treatment

•Program will pay up to $10,000 per calendar year; depending on the patient’s insurance plan patients could have additional financial liability for any amounts over Eisai’s maximum benefit

•HCP and patient must complete form and fax to 18334537362

•Upon enrollment in the program, each patient will be issued a 16digit virtual debit card

•Contact the Eisai Patient Support Program at 18334537362 to obtain further information (Monday–Friday: 8 AM8 PM ET)

Enrollment Forms

Enrollment Form