Affordability options may be available for LOKELMA

LOKELMA Co-pay Savings Card

The LOKELMA Co-pay Savings Card may help you pay a set amount of out-of-pocket costs.

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AZ&Me Prescription Savings Program provides AstraZeneca medicines at no cost if you qualify.

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Independent Patient Assistance Foundations

Assistance may be available through independent foundations such as those listed below. Foundations can provide a variety of assistance types: co-pay, transportation, premium, patient education, etc.

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Who is eligible?

  • You may be eligible for this offer if you are insured by commercial insurance and your insurance does not cover the full cost of your prescription, or you are not insured and are responsible for the cost of your prescriptions. Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DOD) programs or TRICARE, and patients who are Medicare-eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees. If you are enrolled in a state or federally funded prescription insurance program, you may not use this savings card even if you elect to be processed as an uninsured (cash-paying) patient. This offer is not insurance, is restricted to residents of the United States and Puerto Rico, and to patients over 18 years of age.
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What to know

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What happens once an eligible patient gets the LOKELMA Co-pay Savings Card?

A LOKELMA Co-pay Savings Card account will be created for the eligible patient. This can be done by the pharmacy or by calling an Access 360 representative. Once enrolled, the patient will continue to pay a set amount of his or her out-of-pocket costs for LOKELMA. The pharmacy will use the LOKELMA Co-pay Savings Card to cover the balance, up to the program maximum.

What are the specific costs associated with the LOKELMA Co-pay Savings Card?

The patient pays $0 per 30-packet supply, subject to a maximum savings of $350 per 30-packet supply; patient out-of-pocket expenses may vary. If you pay cash for your prescription, AstraZeneca will pay up to the first $250, and you will be responsible for any remaining balance, for each monthly prescription. Other restrictions may apply.

What does the LOKELMA Co-pay Savings Card cover?

The LOKELMA Co-pay Savings Card covers the cost of the drug, but does not cover costs for office visits or any other associated costs.

Are there income requirements to participate in the program?

No. There are no income requirements to participate in the program.

Where can I find additional information?

For additional information, please visit www.astrazenecaspecialtysavings.com or call an Access 360 representative at 1-866-494-8080.

Who can apply?

  • People without health insurance
  • Medicare Part D and/or B recipients
  • Those who have recently experienced a financial crisis
  • Legal residents of the United States or Puerto Rico
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What to know

Eligibility rules apply, please call an AZ&Me representative for more information at 1-800-AZandMe (1-800-292-6363).

Who can apply?

These foundations are not associated with AstraZeneca; specific details and eligibility requirements can be found directly at the foundations’ websites.

Find a foundation

Patient Access Network Foundation

www.PANfoundation.org 1-866-316-7263

Good Days Fund

www.mygooddays.org 1-877-968-7233

Patient Advocate Foundation

www.patientadvocate.org 1-800-532-5274

HealthWell Foundation

www.healthwellfoundation.org 1-800-675-8416

CancerCare Co-Payment Assistance Foundation

www.cancercare.org 1-866-552-6729

The Assistance Fund

www.theassistancefund.org 1-855-845-3663

Leukemia & Lymphoma Society

www.lls.org 1-800-955-4572

Patient Services, Inc.

www.patientservicesinc.org 1-800-366-7741

What to know

For more information and additional resources, visit: https://www.astrazeneca-us.com/medicines/Affordability.html or call an Access 360 representative at 1-866-494-8080.

 
If you are enrolled in a state or Federally funded prescription insurance program, you may not use this program even if you elect to be processed as an uninsured (cash paying) patient. Medicare Part B covers medically necessary services and supplies. Also covers drugs prescribed and administered by a healthcare provider If you are still working, retired, or have purchased a private insurance policy and are receiving prescription coverage through an employer, union, or private insurance plan, you are not eligible for AZ&Me. Also, if you are a current or retired Federal employee (non-military), and receive prescription coverage through the Federal Employees Health Benefits Program (FEHB), you are not eligible for AZ&Me. Finally, if you are military (active or non-active duty) and receive prescription coverage through TRICARE or Veterans Affairs (VA), you are not eligible for AZ&Me. For additional information, please call an AZ&Me representative at 1-800-AZandMe (1-800-292-6363). Medicare Part B refers to Medical Insurance. Generally, these are drugs administered by a doctor or in an outpatient setting. Medicare Part D is Prescription Drug Coverage, which are generally self-administered drugs. Check your patient’s insurance plan to accurately determine the type of coverage they receive. Example: Rob’s take-home pre-tax income is $30,000 per year. Rob’s out of pocket expenses on his prescription cholesterol medication is $100 per month, which is 4% of his annual income. Rob would qualify for AZ&Me if all other eligibility requirements are met.