Fragmin

Indicated For

Venous thromboembolism (VTE), cancer-associated thrombosis, surgical prophylaxis

About This Medication

# Eisai Assistance Program Patient Guide: How to Get **Fragmin (dalteparin sodium)** at Low or No Cost Fragmin (dalteparin sodium) is a low molecular weight heparin used to prevent and treat blood clots, such as deep vein thrombosis (DVT) and pulmonary embolism (PE). The **Eisai Assistance Program** helps low-income, uninsured, or underinsured patients in the US access Fragmin at no cost if they meet eligibility criteria.[1][2][6] ## About Fragmin (dalteparin sodium) **Fragmin** is an anticoagulant injection prescribed to prevent harmful blood clots in conditions like acute coronary syndrome, hip replacement surgery, or abdominal surgery. It works by inhibiting factor Xa, a key protein in the clotting process, reducing the risk of clots without significantly affecting other clotting factors. Administered subcutaneously (under the skin), typical doses range from 2,500 to 18,000 international units daily, depending on your condition, weight, and kidney function. Always follow your doctor's instructions for safe use, as Fragmin can increase bleeding risk—report unusual bruising, blood in urine, or severe headaches immediately.[1][6] This guide explains how the Eisai Assistance Program can make Fragmin affordable or free. The program is sponsored by **Eisai**, the manufacturer, targeting patients facing financial hardship.[2][5][6] ## Who Qualifies for the Eisai Assistance Program? Eligibility focuses on financial need, residency, and insurance status: - **Low-income, uninsured, or underinsured patients** who are legal US residents (Social Security number, Visa, or Green Card required).[2] - Patients must demonstrate financial hardship through required documentation.[2] - **Not for inpatient use**; intended for outpatient prescriptions.[2] - Healthcare provider certification is mandatory.[1][2] Specific income thresholds (e.g., Federal Poverty Level percentages) are not publicly detailed in available resources, but the program serves those with limited resources. Contact the program for personalized assessment.[2][6] ## Income Eligibility Breakdown Detailed income limits are not specified in program documents, emphasizing case-by-case review based on financial proof. Here's a summary: | Household Size | Income Threshold | Notes | |---------------|------------------|-------| | Individual | Not specified | Financial docs required (e.g., tax returns, pay stubs).[2] | | Couple | Not specified | Year-to-date spending on meds considered.[2] | | Family of 3 | Not specified | Low-income focus; call for details.[6] | | Family of 4+ | Not specified | Uninsured/underinsured prioritized.[2] | **Tip**: Provide accurate financial info—verification is required annually or for reauthorization.[2][9] ## Insurance Requirements The program is for **uninsured or underinsured patients**. Attach copies of insurance cards if applicable. Medicare patients may qualify if underinsured, but confirm via phone as coverage varies. Eisai cannot guarantee payer reimbursement.[2][5] ## Step-by-Step Application Process 1. **Discuss with your doctor**: Have them confirm your Fragmin prescription and complete the enrollment form (Sections for patient info, product details, physician certification, insurance, and financials).[1][2] 2. **Gather documents**: - Proof of income: Tax returns, W-2s, Social Security statements, pay stubs (one month's worth), unemployment/disability statements.[2] - Insurance cards (both sides, if any).[2] - Patient ID: SSN, DOB, address.[2] 3. **Complete the form**: Patient signs for authorization; doctor certifies medical need.[2] 4. **Submit**: - **Phone**: Call 1-866-613-4724 (Mon-Fri, 8 AM-8 PM ET) to start.[2][5] - **Fax**: 1-855-246-5192 with all docs.[2] - Online electronic signature possible via Eisai Patient Support site.[4][5] 5. **Await approval**: Processed within 48 hours typically.[2] Your doctor or pharmacy receives the medication or voucher.[1] ## Timeline and Delivery - **Processing**: Within 48 hours of complete submission.[2] - **Delivery**: Shipped to doctor's office or pharmacy; use a pharmacy card for pickup.[1][2] - **Reauthorization**: Required periodically—submit reverification form annually.[2][9] ## Alternatives if Denied or Ineligible - **Appeal**: Contact the hotline for review.[5] - **Other programs**: Check PAN Foundation, HealthWell Foundation, or generic low molecular weight heparins like enoxaparin (Lovenox PAP).[6] - **Copay cards**: If insured, ask about Eisai reimbursement support.[5] - **State assistance**: Medicaid or 340B programs for qualifying clinics. - **Biosimilars**: None currently listed for Fragmin.[ ] ## Important Disclaimer This guide is for informational purposes based on available program details as of latest forms (e.g., Dec 2024).[2] Eligibility, terms, and availability can change—**always verify directly with Eisai at 1-866-613-4724**. Not medical advice; consult your healthcare provider. Eisai disclaims liability for coverage decisions. Program may end or modify criteria without notice.[2][5] Word count: 942.

Program information last verified: March 30, 2026