Banzel

Indicated For

Lennox-Gastaut syndrome

About This Medication

# Eisai Banzel Patient Assistance Program: How to Get Banzel at Low or No Cost ## About This Program The Eisai Banzel Patient Assistance Program is designed to help patients who cannot afford their Banzel (rufinamide) medication. Banzel is an antiepileptic drug used to treat Lennox-Gastaut syndrome, a severe form of epilepsy that typically begins in early childhood. If you've been prescribed Banzel but are struggling with the cost, this program may be able to help you get your medication for free or at a significantly reduced price. ## Who Can Qualify? You may be eligible for the Eisai Banzel Patient Assistance Program if you meet these criteria: - **You have a valid prescription** for Banzel from your doctor - **You are a U.S. resident** - **Your household income is at or below 300% of the Federal Poverty Level (FPL)** - **Your insurance situation falls into one of these categories:** - You are uninsured (have no health insurance) - Your insurance has denied coverage for Banzel - You are waiting to receive public assistance (like Medicaid) - **Note:** If you have Medicare Part D coverage, you are not eligible for this program ## Income Eligibility Chart Use this chart to see if your household income qualifies (at 300% of Federal Poverty Level): | Household Size | Maximum Annual Income | |---|---| | 1 person | $39,750 | | 2 people | $53,850 | | 3 people | $67,950 | | 4 people | $82,050 | | 5 people | $96,150 | | 6 people | $110,250 | | 7 people | $124,350 | | 8 people | $138,450 | *Note: These income limits are based on 2024 Federal Poverty Guidelines and may be updated annually.* ## What You'll Need to Apply Before you start your application, gather these documents: - **Proof of Income:** Recent pay stubs, tax returns, or a letter from your employer showing your annual income - **Insurance Information:** Your insurance card (both sides) or proof that you are uninsured - **Prescription Information:** Your Banzel prescription from your doctor - **Contact Information:** Your phone number, mailing address, and email ## How to Apply: Step-by-Step Instructions ### Step 1: Contact the Program You have three ways to apply: **By Phone:** Call (888) 796-1234. A representative can guide you through the application over the phone and answer any questions. This is often the fastest method. **By Fax:** You can request an application form and fax your completed application to (888) 430-9818. **Online:** Visit the program website at https://www.rxhope.com/PAP/info/PAPList.aspx?companyid=115&fieldType=companyid to apply online or download an application form. ### Step 2: Complete Your Application Provide accurate information about: - Your personal demographics (name, date of birth, address) - Your household size and total annual income - Your current insurance status - Your doctor's name and contact information - Your prescription details ### Step 3: Submit Required Documents Include copies (not originals) of: - Proof of income - Insurance card or proof of being uninsured ### Step 4: Wait for Approval The program typically processes applications within 24-48 hours. You'll be notified of approval or if they need additional information. ### Step 5: Receive Your Medication Once approved, your Banzel will be shipped directly to either: - Your home address, or - Your doctor's office (whichever you prefer) Shipping is included at no cost to you. ## Timeline and What to Expect **Processing Time:** 24-48 hours from submission **Delivery:** Your medication will be shipped to your preferred address (home or doctor's office) at no cost **Duration:** The assistance is typically provided on a monthly basis, but you will need to reauthorize your participation **once per year** ## Reauthorization (Annual Renewal) Your assistance doesn't continue automatically. Here's what you need to know: - **When:** You'll need to reapply once per year - **Why:** The program checks to ensure you still meet the income and insurance requirements - **How:** The program will contact you when it's time to renew. Simply provide updated proof of income and insurance information - **Timing:** Reauthorize before your current assistance expires to avoid any gaps in receiving your medication ## What If Your Application Is Denied? If you don't qualify for the Eisai Banzel Patient Assistance Program, consider these alternatives: 1. **Talk to Your Doctor:** Your healthcare provider may have samples of Banzel or know of other resources 2. **Check Other Assistance Programs:** Some states offer pharmaceutical assistance programs 3. **Contact Patient Advocacy Organizations:** Organizations focused on epilepsy may have additional resources 4. **Explore Insurance Options:** If you're uninsured, you may qualify for Medicaid or marketplace insurance 5. **Ask About Generic Alternatives:** Ask your doctor if there are other antiepileptic medications that might be more affordable ## Important Information - This program is **only for Banzel (rufinamide)** — it does not provide assistance with other medications - You must have a valid prescription from a licensed healthcare provider - Income limits and requirements are subject to change - This program is provided by Eisai and is separate from your insurance coverage ## Contact Information Summary **Program Name:** Eisai Banzel Patient Assistance Program **Phone:** (888) 796-1234 **Fax:** (888) 430-9818 **Website:** https://www.rxhope.com/PAP/info/PAPList.aspx?companyid=115&fieldType=companyid **Processing Time:** 24-48 hours ## Legal Disclaimer This guide is for informational purposes only and does not constitute medical advice or a guarantee of program benefits. Eligibility requirements, income limits, and program terms are subject to change at any time. Please contact the program directly or visit the official website for the most current information. Eisai Inc. reserves the right to modify or discontinue this program at any time. Always consult with your healthcare provider before making any changes to your medication or treatment plan.

Program information last verified: March 25, 2026