Commercially insured patients may
PAY AS LITTLE AS $0*
Connect your patients with the EOHILIA Patient Support and Copay Program
AUTHORIZE
To support coverage authorization for your patients with commercial insurance, you can submit a Letter of Medical Exception or a Letter of Appeal.
Get started now! Download digital templates of each letter.
SIGN UP
Patients can sign up for a digital copay card by visiting EOHILIA.com/copay-savings/ or calling 1-866-861-1482 to find out if they’re eligible.
If patients are eligible, they can download and print their digital card.
SAVE
Patients should present their digital copay card to their pharmacy to get EOHILIA for as little as $0 for their first 30-day prescription.*
Share helpful information with your patients.
*Terms and conditions apply.
View the EOHILIA Patient Support and Copay Program Terms and Conditions
Information to help streamline the prescription process
Electronic Health Records (EHR) system insurance coverage process
Like all new brands, gaining formulary coverage takes time. The below process can help you navigate patient access for our new product. If EOHILIA isn’t available or listed on your EHR platform, your Takeda regional business manager can help you load it into the system. Click here to Request a Rep.
Prescribe EOHILIA through your EHR system
Provide the patient with the EOHILIA Copay Program Overview
Eligible, commercially insured patients may pay as little as $0 if EOHILIA is covered by their commercial insurance, per 30-day supply of EOHILIA. Eligible patients may pay as little as $0 if EOHILIA is covered by their commercial insurance, per 30-day supply of EOHILIA, with a max annual benefit of up to $2500 off their copay or out-of-pocket expenses. Please see Terms and Conditions. Download EOHILIA Copay Program Overview
If a PA is required, submitting a Letter of Medical Exception (LME) with it may be helpful
An electronic PA (ePA) is sent to your office if a PA is required. It is important to fully complete the PA, and provide all supporting information like medical and treatment history, which may include over-the-counter medications. If you choose to also submit an LME with the PA, we have a sample LME available as a reference guide. The PA form and all supporting documents, including LME, can be submitted electronically, or by fax.
If not covered or not approved, we have several resources that may provide your office with helpful information
If the prescriber is notified that PA and/or LME have been rejected through the EHR, or through a call from the pharmacy, or the patient, resources like the Sample LOA or EOHILIA At a Glance may provide your office with helpful information at this stage.
Once coverage is resolved and if coverage is approved, eligible patients may be able to pay as little as $0 for their prescription fill of EOHILIA.
Resources to help
For Your Office Team
Letter of Medical Exception
Refer to this letter template to help compose letters to accompany prior authorizations or when submitting a formulary exception request.
Letter of Appeal
Refer to this letter when submitting an appeal to a denied claim for EOHILIA, where appropriate.
For Your Patients
EOHILIA Savings Program Brochure
An introduction to the EOHILIA Patient Support and Copay Program for commercially insured patients. See terms and conditions.
EOHILIA FAQ Guide for Patients
Help your patients navigate their treatment journey by providing them with this guide intended to answer questions they may have about savings and coverage for EOHILIA.
Frequently Asked Questions
The out-of-pocket cost for EOHILIA can vary and depends on your patient’s insurance plan. Depending on the plan, patients may be asked to pay a copay, coinsurance, or the full amount for each prescription. With the EOHILIA Patient Support and Copay Program, eligible commercially insured patients may pay as little as $0 for their 30-day prescription fill if EOHILIA is covered by their commercial insurance.*
This offer provides copay assistance for commercially insured patients who qualify. The copay program cannot be used if patient is a beneficiary of, or any part of the prescription is covered by:
- Any federal, state, or government-funded healthcare program (Medicare, Medicare Advantage, Medicaid, TRICARE, etc), including a state pharmaceutical assistance program (the Federal Employees Health Benefit [FEHB] Program is not a government-funded healthcare program for the purpose of this offer)
- The Medicare Prescription Drug Program (Part D), or if patient is currently in the coverage gap
- Insurance that is paying the entire cost of the prescription. Additional terms and conditions apply. Please see the full Terms and Conditions here
Provide your commercially insured patients with the EOHILIA Copay Program Overview, which outlines how to register to see if they’re eligible and how to access their digital copay card.
Coverage Support FAQs
We are committed to supporting your patients’ access to EOHILIA, as prescribed. Each insurer determines its own policies, and, like all new medications, gaining formulary coverage takes time. Our focus is to ensure that patients can get started on treatment with EOHILIA, as prescribed.
Click here to learn more about other terms and conditions.
Like all new brands, gaining formulary coverage takes time. If EOHILIA isn’t available or listed on your EHR platform, your Takeda regional business manager can help you load it into the system.
Click here to request a representative.
In some cases, a Letter of Medical Exception (LME) or a Letter of Appeal (LOA) from the physician may be required for a medication to be covered. You can download a checklist and sample letters here:
Here are the diagnosis codes2,3:
ICD-10 code for eosinophilic esophagitis: K20.0
ICD-11 code for eosinophilic esophagitis: DA24.1
Eligible patients may pay as little as $0 if EOHILIATM (budesonide oral suspension) is covered by their commercial insurance, up to $600 per 30-day supply of EOHILIATM, with a max annual benefit of up to $2500 off their copay or out-of-pocket expenses. A valid Prescriber ID# is required on the prescription. Offer not valid for cash paying patients. You must be 18 years or older to use the EOHILIA™ Copay Offer for yourself or a minor.
Patient Instructions: Follow the dosage instructions given by the doctor. This offer may not be redeemed for cash. By using this offer, you are certifying that you meet the eligibility criteria and will comply with the terms and conditions described in the Terms and Conditions section below and understand and acknowledge the Takeda Privacy Notice (www.takeda.com/privacy-notice). Patients with questions about the EOHILIA™ Copay Offer should call 1-866-861-1482.
Pharmacist Instructions: When you apply this offer, you certify that: (1) you have not submitted and will not submit a claim for reimbursement for the portion of the prescription covered by this offer to any payer; (2) your participation in this program is consistent with all applicable laws and any obligations, contractual or otherwise, that you may have as a pharmacy provider; (3) By participating in this program, you are certifying that you will comply with the terms and conditions described.
Pharmacist Instructions For A Patient With An Eligible Third Party: Submit the claim to the primary Third Party Payer first, then submit the balance due to CHANGE HEALTHCARE as a Secondary Payer COB [coordination of benefits] with patient responsibility amount and a valid Other Coverage Code, (e.g. 8). The patient pay amount submitted will be reduced by up to $1800 and reimbursement will be received from CHANGE HEALTHCARE. Valid Other Coverage Code required. For any questions regarding Change Healthcare online processing, please call the Help Desk at 1-800-433-4893.
Terms and Conditions: The Eohilia™ Copay Offer (“Offer”) provides financial support for commercially insured patients who qualify for the Offer. By using this Offer, the patient certifies that the program is intended solely for his or her benefit—not health plans and/or their partners. This Offer cannot be used if patient is a beneficiary of, or any part of the prescription is covered by: (1) any federal, state, or government-funded healthcare program (Medicare, Medicare Advantage, Medicaid, TRICARE, etc.), including a state pharmaceutical assistance program (the Federal Employees Health Benefit (FEHB) Program is not a government-funded healthcare program for the purpose of this Offer), (2) the Medicare Prescription Drug Program (Part D), or if patient is currently in the coverage gap, or (3) insurance that is paying the entire cost of the prescription. Patient may not seek reimbursement from any other plan or program (Flexible Spending Account [FSA], Health Savings Account [HSA], Health Reimbursement Account [HRA], etc.) for any out-of-pocket costs covered by this Offer. Cash Discount Cards and other non-insurance plans are not valid as primary under this Offer. This does not constitute health insurance. By using this Offer, the patient certifies that he or she will comply with any terms of his or her health insurance contract requiring notification to his or her payer of the existence and/or value of this Offer. It is illegal to (or offer to) sell, purchase, or trade this Offer. This Offer is not transferable and is limited to one Offer per person and may not be combined with any other coupon, discount, prescription savings card, rebate, free trial, patient assistance, co-pay maximizer, alternative funding program, co-pay accumulator, or other offer, including those from third parties and companies that help insurers or health plan manage costs. This Offer is valid in the United States, including Puerto Rico and other U.S. territories. This Offer is not valid if reproduced. Void where prohibited by: your insurance provider, law, taxed, or restricted. By utilizing this Offer, you hereby accept and agree to abide by these terms and conditions. Any individual or entity who enrolls or assists in the enrollment of a patient in this Offer represents that the patient meets the eligibility criteria and other requirements described herein. You must meet the program eligibility requirements every time you use the program. Program managed by ConnectiveRx on behalf of Takeda Pharmaceuticals U.S.A., Inc. The parties reserve the right to rescind, revoke, or amend this Offer without notice at any time.
EOHILIATM (budesonide oral suspension) Copay Offer Terms and Conditions
Eligible patients may pay as little as $0 if EOHILIATM (budesonide oral suspension) is covered by their commercial insurance, up to $600 per 30-day supply of EOHILIATM, with a max annual benefit of up to $2500 off their copay or out-of-pocket expenses. A valid Prescriber ID# is required on the prescription. Offer not valid for cash paying patients. You must be 18 years or older to use the EOHILIATM Copay Offer for yourself or a minor.
Patient Instructions: Follow the dosage instructions given by the doctor. This offer may not be redeemed for cash. By using this offer, you are certifying that you meet the eligibility criteria and will comply with the terms and conditions described in the Terms and Conditions section below and understand and acknowledge the Takeda Privacy Notice (www.takeda.com/privacy-notice). Patients with questions about the EOHILIATM Copay Offer should call 1-866-861-1482.
Pharmacist Instructions: When you apply this offer, you certify that: (1) you have not submitted and will not submit a claim for reimbursement for the portion of the prescription covered by this offer to any payer; (2) your participation in this program is consistent with all applicable laws and any obligations, contractual or otherwise, that you may have as a pharmacy provider; (3) By participating in this program, you are certifying that you will comply with the terms and conditions described.
Pharmacist Instructions For A Patient With An Eligible Third Party: Submit the claim to the primary Third Party Payer first, then submit the balance due to CHANGE HEALTHCARE as a Secondary Payer COB [coordination of benefits] with patient responsibility amount and a valid Other Coverage Code, (e.g. 8). The patient pay amount submitted will be reduced by up to $1800 and reimbursement will be received from CHANGE HEALTHCARE. Valid Other Coverage Code required. For any questions regarding Change Healthcare online processing, please call the Help Desk at 1-800-433-4893.
Terms and Conditions: The EohiliaTM Copay Offer (“Offer”) provides financial support for commercially insured patients who qualify for the Offer. By using this Offer, the patient certifies that the program is intended solely for his or her benefit—not health plans and/or their partners. This Offer cannot be used if patient is a beneficiary of, or any part of the prescription is covered by: (1) any federal, state, or government-funded healthcare program (Medicare, Medicare Advantage, Medicaid, TRICARE, etc.), including a state pharmaceutical assistance program (the Federal Employees Health Benefit (FEHB) Program is not a government-funded healthcare program for the purpose of this Offer), (2) the Medicare Prescription Drug Program (Part D), or if patient is currently in the coverage gap, or (3) insurance that is paying the entire cost of the prescription. Patient may not seek reimbursement from any other plan or program (Flexible Spending Account [FSA], Health Savings Account [HSA], Health Reimbursement Account [HRA], etc.) for any out-of-pocket costs covered by this Offer. Cash Discount Cards and other non-insurance plans are not valid as primary under this Offer. This does not constitute health insurance. By using this Offer, the patient certifies that he or she will comply with any terms of his or her health insurance contract requiring notification to his or her payer of the existence and/or value of this Offer. It is illegal to (or offer to) sell, purchase, or trade this Offer. This Offer is not transferable and is limited to one Offer per person and may not be combined with any other coupon, discount, prescription savings card, rebate, free trial, patient assistance, co-pay maximizer, alternative funding program, co-pay accumulator, or other offer, including those from third parties and companies that help insurers or health plan manage costs. This Offer is valid in the United States, including Puerto Rico and other U.S. territories. This Offer is not valid if reproduced. Void where prohibited by: your insurance provider, law, taxed, or restricted. By utilizing this Offer, you hereby accept and agree to abide by these terms and conditions. Any individual or entity who enrolls or assists in the enrollment of a patient in this Offer represents that the patient meets the eligibility criteria and other requirements described herein. You must meet the program eligibility requirements every time you use the program. Program managed by ConnectiveRx on behalf of Takeda Pharmaceuticals U.S.A., Inc. The parties reserve the right to rescind, revoke, or amend this Offer without notice at any time.
References:
- EOHILIA (budesonide oral suspension) Prescribing Information. Takeda Pharmaceuticals, Inc.
- ICD10Data.com. The Web’s Free 2023 ICD-10-CM/PCS Medical Coding Reference. October 1, 2022. Accessed January 16, 2024.
- World Health Organization. International Classification of Diseases. 11th revision. World Health Organization; 2022. Accessed January 16, 2023.