Leqembi Patient Assistance Program

Funded

About

The Leqembi Patient Assistance Program offers invaluable support by providing the drug Leqembi at no cost to uninsured and financially struggling patients who meet the eligibility criteria. With easy enrollment and renewal processes, the Leqembi Patient Assistance Program helps ensure that patients receive essential medication without financial burden, reinforcing their commitment to accessible healthcare.

Insurance requirements: Uninsured

Enrollment Forms

Enrollment Form

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: Yes

•Activation Required: No

Program Details

•Provides LEQEMBI at no cost to uninsured and financially burdened patients who meet the program eligibility criteria

•Must have a valid prescription

•Limitations may apply

•HCP and patient must complete form and fax to 18337707017

•To obtain further information please call 18334537362 (Monday through Friday, 8 AM to 8 PM ET)

Enrollment Forms

Enrollment Form