Fycompa Patient Assistance Programs

Fycompa: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Fycompa. Review the information to see if you qualify. The applications are available in Adobe PDF format and should be mailed directly to the provider of the patient assistance program.

If you have any questions, please call the telephone number for the program (not PharmacyChecker.com) or go to the program website.

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Eisai Fycompa CIII Patient Assistance Program

(Program 1 of 1 — Scroll down to see them all )

Provided by: Eisai, Inc.
2250 Perimeter Park Drive Suite 300 Morrisville, NC 27560
TEL: 855-347-2448
FAX: 888-668-8136
Languages Spoken:
English
Program Website
Medications
  • Fycompa (perampanel)
Eligibility Requirements
  • Insurance Status Must be uninsured, denied coverage or are awaiting public assistance determination
  • Those with Part D Elibible? No
  • Income At or below 300% of FPL
  • Diagnosis/Medical Criteria Medically Necessary as determined by a Doctor
  • U.S. Residency Required? Must be a US resident
Application
  • Obtaining Call or download
  • Receiving Faxed or mailed
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section and sign
  • Applicant's Action Complete section, sign, attach a copy of proof of income
  • Decision Communicated Patient and/or Doctor are notified
  • Decision Timeframe Varies
Medication
  • Amount/Supply Varies
  • Sent To Patient is sent savings card to be used at pharmacy
  • Delivery Time Not specified
  • Refill Proces Good for one year
  • Limit None
  • Re-application New application every 12 months
Additional Information
This program also provides copay assistance. This program also offers a Savings Card Program: Card activation is required.
Updated September 21, 2018

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for prices here.

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