Aloxi

Indicated For

Chemotherapy-induced nausea and vomiting (CINV), postoperative nausea and vomiting (PONV)

About This Medication

# Eisai Oncology Patient Assistance Program Patient Guide: How to Get Aloxi at Low or No Cost ## About This Program The **Eisai Oncology Patient Assistance Program** provides **Aloxi (palonosetron hydrochloride) at no cost** to eligible patients who cannot afford their medication. Aloxi is an antiemetic medication used to prevent nausea and vomiting in cancer patients undergoing chemotherapy. If you're struggling to pay for this essential medication, this program may be able to help. ## About Aloxi Aloxi is a selective 5-HT3 receptor antagonist prescribed to prevent chemotherapy-induced nausea and vomiting (CINV). It's typically administered intravenously before chemotherapy treatment begins. By controlling nausea and vomiting, Aloxi helps patients maintain better nutrition, complete their cancer treatment as planned, and improve their overall quality of life during chemotherapy. ## Who Qualifies for This Program You may be eligible for the Eisai Oncology Patient Assistance Program if you meet ALL of the following criteria: - **U.S. Residency**: You must be physically present and residing in the continental United States - **Treating Physician**: You must have a U.S. treating physician who can prescribe and administer Aloxi - **Insurance Status**: You must be uninsured or underinsured without access to prescription drug coverage - **Financial Need**: You must meet specific financial criteria demonstrating inability to afford the medication - **Legal Status**: You must be a legal U.S. resident (Social Security number, Visa, or Green Card required) ## Income Eligibility While the program does not publish specific income thresholds, it is designed for patients with **financial need** who lack access to prescription drug coverage. The program evaluates each application individually based on: - Your household income - Your current out-of-pocket medical expenses - Your insurance status and coverage gaps - Your ability to pay for Aloxi | Eligibility Factor | Requirement | |---|---| | **Insurance Status** | Uninsured or underinsured without prescription drug coverage | | **Financial Documentation** | Required to demonstrate financial need | | **U.S. Residency** | Continental U.S. only | | **Physician Requirement** | Must have active U.S. treating physician | | **Legal Status** | Legal U.S. resident | ## Insurance Requirements This program is specifically designed for patients who are: - **Uninsured**: You have no health insurance coverage - **Underinsured**: You have health insurance but it does not cover Aloxi or your out-of-pocket costs are prohibitively high - **Without Prescription Drug Coverage**: Your insurance plan does not include prescription medication benefits If you have insurance that covers Aloxi, you should explore your insurance benefits first. However, if your copay or coinsurance is unaffordable, you may still qualify for assistance. ## Step-by-Step Application Process ### Step 1: Contact Eisai Patient Support Call **1-866-613-4724** (toll-free) to request an application form. Have the following information ready: - Your full name and date of birth - Your treating physician's name and contact information - Your current insurance information (if applicable) - A brief description of your financial situation ### Step 2: Gather Required Financial Documentation Prepare copies of the following documents to verify your financial need: - Recent Social Security benefit statements (if applicable) - One month's worth of recent paycheck stubs - Unemployment or disability statements (if applicable) - Proof of other income sources - Current medical bills or statements showing out-of-pocket expenses ### Step 3: Complete the Enrollment Form Your physician or you will complete the official Eisai Patient Assistance Program enrollment form. The form requires: - Complete patient information - Insurance information (attach copies of insurance cards if available) - Physician certification and shipping information - Financial information section with year-to-date out-of-pocket spending - Patient authorization and signature **Important**: The enrollment cannot be processed without your signature on the authorization section. ### Step 4: Submit Your Application Fax your completed enrollment form along with copies of your financial documentation to: **Fax: 1-855-246-5192** Alternatively, you can mail the form to the address provided by Eisai Patient Support if you prefer not to fax. ### Step 5: Await Eligibility Determination Eisai Patient Support will review your application and contact you or your physician regarding your eligibility status. Keep your phone number current so they can reach you. ## Timeline and Medication Delivery **Processing Time**: The search results do not specify an exact processing timeline. However, most patient assistance programs typically process applications within 5-10 business days. Contact Eisai Patient Support at **1-866-613-4724** for an estimate specific to your application. **Delivery Method**: Once approved, Aloxi will be shipped to either your treating physician's office or directly to you, depending on what is arranged during the application process. Your physician will coordinate the delivery and administration of the medication. **Important Note**: Aloxi provided through this program is for **outpatient use only**. Inpatient use of medication obtained through the patient assistance program is not permitted. ## What Happens If Your Application Is Denied If you are denied assistance, you have several options: 1. **Appeal**: Contact Eisai Patient Support to understand the reason for denial and ask about the appeal process 2. **Explore Other Resources**: Ask your physician about: - Other patient assistance programs - Hospital financial assistance programs - Cancer support organizations that may help with medication costs - Clinical trials that may provide free medication 3. **Reapply**: If your financial situation changes, you may reapply for the program 4. **Insurance Options**: Explore whether you qualify for Medicaid, Medicare, or marketplace insurance plans ## Important Limitations and Disclaimers - **No Guarantee of Payment**: Eisai cannot guarantee payment of any claim. Coverage and reimbursement decisions are made by individual payers following their own policies. - **Program Modifications**: Eisai reserves the right to modify eligibility criteria or terminate the program at any time - **Outpatient Use Only**: Medication provided through this program cannot be used during inpatient hospital stays - **Legal U.S. Residency Required**: You must provide proof of legal U.S. residency (Social Security number, Visa, or Green Card) - **Physician Involvement Required**: Your treating physician must be involved in the application and medication administration process ## Contact Information **Eisai Patient Support** - **Phone**: 1-866-613-4724 (1-866-61-EISAI) - **Fax**: 1-855-246-5192 - **Hours**: Monday–Friday, 8 AM–8 PM ET - **Website**: www.eisaipatientsupport.com Don't let cost prevent you from receiving the cancer care you need. Reach out to Eisai Patient Support today to learn if you qualify for assistance with Aloxi.

Program information last verified: March 30, 2026