Fycompa

Indicated For

focal seizures

About This Medication

# Eisai Assistance Program for FYCOMPA Patient Guide: How to Get Fycompa at Low or No Cost Fycompa (perampanel) is a prescription medication used to treat partial-onset and primary generalized tonic-clonic seizures in people with epilepsy. The **Eisai Assistance Program for FYCOMPA** helps eligible patients get Fycompa at no cost if they meet income and insurance criteria.[1][2] ## About Fycompa **Fycompa (perampanel)** is an antiepileptic drug (AED), classified as a Schedule CIII controlled substance. It works by blocking AMPA receptors in the brain to reduce excessive electrical activity that causes seizures. The FDA has approved Fycompa for: - Adjunctive therapy for partial-onset seizures with or without secondarily generalized seizures in patients aged 4 years and older. - Adjunctive therapy for primary generalized tonic-clonic seizures in patients with epilepsy aged 12 years and older. - Monotherapy for partial-onset seizures in patients aged 4 years and older.[6][8] Common side effects include dizziness, sleepiness, fatigue, irritability, nausea, and falls. Serious risks involve suicidal thoughts, aggression, and misuse potential due to its controlled status. Always take as prescribed by your doctor and report side effects to your healthcare provider or FDA at 1-800-FDA-1088.[1] This program provides free medication to those who qualify, easing the financial burden of epilepsy treatment, which can cost thousands annually without assistance. ## Who Qualifies? To qualify for the **Eisai Assistance Program for FYCOMPA**, you must: - Be a **U.S. resident** (proof like Social Security number, Visa, or Green Card may be required).[1][4] - Have **limited income** based on annual household income and household size (exact thresholds not publicly specified; reviewed case-by-case).[1][2] - Be **uninsured or underinsured**, but **not enrolled in Medicare, Medicaid, Tricare, VA, or other federal/state healthcare plans**.[1] - Provide all required documentation. The program does not guarantee approval; completing the form is just the first step.[1][2][4] ## Income Eligibility Breakdown Eligibility is based on **annual household income**, considering total people in the household (including you). Specific dollar thresholds or Federal Poverty Level (FPL) percentages are **not publicly listed**—Eisai reviews applications individually using your provided documents.[1][2] Submit proof like federal tax returns, Social Security statements, unemployment/disability letters, or one month's pay stubs. You may need government ID (driver's license, passport, etc.).[1][2][5] Here's a general guide to prepare (based on typical PAP structures; confirm with Eisai): | Household Size | Estimated Income Consideration | Notes | |---------------|-------------------------------|-------| | 1 person | Low-income threshold | Attach tax return or pay stubs[1] | | 2 people | Scaled by household size | Include all residents[1] | | 3 people | Documentation required | Social Security statements OK[2] | | 4+ people | Case-by-case review | Exact limits not specified[1][5] | **Tip**: Call (888) 392-6674 (Mon-Fri, 8 AM-5 PM ET) for guidance on your situation before applying.[2][5] ## Insurance Requirements - **Uninsured or underinsured** patients qualify; attach insurance cards if any coverage exists.[1][2] - **Ineligible** if on **Medicare, Medicaid, Tricare, VA, or federal/state plans**.[1] - Commercial insurance gaps may qualify you as underinsured. - Program ships to patients, not inpatient facilities.[7] ## Step-by-Step Application Process 1. **Download the form**: Get the latest enrollment form from Eisai's site or call (888) 392-6674.[2][5] 2. **Fill it out completely**: Include patient info, **physician details** (name, contact, prescription: strength, dosage, quantity), **insurance info**, **household income**, and **household size**. Patient and physician must sign.[1][2] 3. **Gather documents**: - Proof of income (tax returns, pay stubs, etc.).[1][2][5] - Insurance cards (if applicable).[1] - Government ID if requested.[2] 4. **Fax everything** to **1-844-633-8444**. (Some older forms list other faxes; use this confirmed number.)[1][2][4][5] 5. **Optional mail**: Eisai Assistance Program, 2250 Perimeter Park Drive, Suite 300, Morrisville, NC 27560.[1] **Pro tip**: Write legibly, complete all sections, and double-check signatures to avoid delays.[1][2] ## Timeline and Delivery - **Processing**: Typically **2-4 weeks**, but incomplete apps delay it.[1][5] - **Approval notice**: Mailed to you, faxed to doctor.[1][2][4] - **Denial notice**: Same process if not eligible.[1][2] - **Delivery**: Medication **shipped directly to your home** (not doctor or pharmacy).[1] - **Validity**: Up to **1 year** (or through Dec 31, 2025 in some forms); **reauthorization required** with new form.[2][4][5] For refills, your doctor may need to confirm ongoing need. ## Alternatives if Denied - **Appeal**: Review denial letter; resubmit with more/better docs or call for advice.[1] - **Savings Card**: Check Fycompa's Instant Savings Card for copay help (restrictions apply).[3] - **Other PAPs**: Simplefill (1-877-386-0206) or Epilepsy Foundation resources.[9][10] - **Generic/biosimilars**: None available.[1] - **State programs** or 340B clinics for low-income patients. Contact Eisai at (888) 392-6674 for denial reasons and next steps.[2] ## Disclaimer This guide is for informational purposes based on publicly available program details as of 2026. Eligibility, terms, and contacts can change—**always verify with Eisai directly at (888) 392-6674 or via official forms**.[1][2][5] Not medical or legal advice. Consult your doctor for treatment decisions. Eisai may update income thresholds or rules without notice. Program completion does not guarantee approval.[1][4]

Program information last verified: March 30, 2026