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Zonegran Patient Assistance Program

Summary

Eisai, Inc. was founded in 1995 as a U.S. Pharmaceutical subsidiary of Tokyo-based Eisai Co., Ltd.. Eisai, Inc. is considered to be in the top 25 pharmaceutical companies worldwide thanks to their development of the donepezil and rabeprazole molecule. Eisai, Inc. developes and produces therapies through co-promotion with other pharmaceutical companies.

Zonegran is a sulfa drug launched by Eisai, Inc. in 2000. Zonegran has been approved by the FDA as part the treatment of focal seizures in epileptic adults. Zonegran is administered in tablet form.

Eligibility

Zonegran Patient Assistance Program, a patient assistance program provided by Eisai, Inc., offers Zonegran at no cost for up to 90 days to those who are eligible for the program. Eligibility is based off of the following requirements:

  • You must be a citizen of the United States or its Territories.
  • You must not be covered by private or public health insurance.
  • Your income must be less than or equal to 250% of the Federal Poverty Guideline for the size of your household (see chart below).
  • Those eligible for Medicare Part D but not enrolled may still be eligible.

    The medication must be sent to the physicians office.

    SOURCE: 2008 Poverty Chart
    Family Size
    300%
    250%
    200%
    150%
    133%
    100%
    1
    $32,490
    $27,075
    $21,660
    $16,245
    $14,404
    $10,830
    2
    $43,710
    $36,425
    $29,140
    $21,855
    $19,378
    $14,570
    3
    $54,930
    $45,775
    $36,620
    $27,465
    $24,352
    $18,310
    4
    $66,150
    $55,125
    $44,100
    $33,075
    $29,327
    $22,050
    5
    $77,370
    $64,475
    $51,580
    $38,685
    $34,301
    $25,790
    6
    $88,590
    $73,825
    $59,060
    $44,295
    $39,275
    $29,530
    7
    $99,810
    $83,175
    $66,540
    $49,905
    $44,249
    $33,270
    8
    $111,030
    $92,525
    $74,020
    $55,515
    $49,223
    $37,010
    Each Additional Family Member
    $11,220
    $9,350
    $7,480
    $5,610
    $4,974
    $3,740

    What´s Next?

    Fill out the program enrollment form located to your right. If you don't see an enrollment form available please call Eisai Inc program directly. After filling out the enrollment form please bring the form to your doctor for proper signatures and procedures. Do not forget a self stamped envelope for them to mail in your application to the program.

    Other Tips

    • If you have any questions please call the Eisai Inc program directly.
    • Fill out as much of the information on the enrollment form as possible. The more information you have pre-filled the easier the progrm is to enroll in.
    • Write down the refill dates for your program and set a reminder here on PatientAssistance.com so that you don't run out of medication.
    • Do not write messy on your forms as this will delay any response.
    • Call and write thank you notes to AAI Pharma Inc. program. Without their help millions of people will be without medication.

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