My LOKELMA support program logo
  • Insurance coverage and access support
  • Co-pay information
  • Educational information

The My LOKELMA Support Program team can also provide additional information if you are in need of financial assistance.

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My LOKELMA Support Program Enrollment Form

To get started in the My LOKELMA Support Program, download the Enrollment Form. Once completed and signed by you and your healthcare provider, fax the form to 1-855-880-5258.

DOWNLOAD THE FORM: English Spanish

YOU COULD PAY $0 FOR 12 MONTHS

LOKELMA Coupon Copay Card
  • Download and bring the $0 Co-pay Savings Card and a valid prescription to your pharmacy
  • No activation required

*Subject to eligibility rules below; restrictions apply.

ELIGIBILITY: 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.

TERMS OF USE: Eligible commercially insured patients with a valid prescription for LOKELMA® (sodium zirconium cyclosilicate) who present this savings card at participating pharmacies will pay as low as $0 for up to a 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. Patient is responsible for applicable taxes, if any. Non-transferable, limited to one per person, cannot be combined with any other offer. Void where prohibited by law, taxed or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility and terms of use at any time without notice. This offer is not conditioned on any past, present or future purchase, including refills. Offer must be presented along with a valid prescription at the time of purchase. Maximum savings limit applies. For additional details about this offer, please visit www.lokelmasavings.com. If you have any questions regarding this offer, please call 1-844-565-3562.

BY USING THIS CARD, YOU AND YOUR PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

Pharmacist Instructions for a Patient With an Eligible Third Party:

For Insured/Covered Patients: Submit the claim to the primary Third-Party Payer first, then submit the balance due to Change Healthcare as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code of 8. This will reduce the eligible patient’s out-of-pocket costs to as low as $0 for up to a 30-packet supply, subject to a maximum savings limit of $350 per 30-packet supply; patient out-of-pocket expenses may vary. Reimbursement will be received from Change Healthcare.

Pharmacist Instructions for Insured/Not Covered Patients: Submit the claim to the primary Third-Party Payer first; if the primary claim submission shows a managed care restriction (step-edit, prior authorization or NDC block), continue the claim adjudication process and submit the balance due to Change Healthcare as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code of 3. This will reduce eligible patient’s out-of-pocket costs to as low as $0 for up to 30-packet supply, subject to a maximum savings limit of $350 per 30-packet supply; patient out-of-pocket expenses may vary. Reimbursement will be received from Change Healthcare.

Pharmacist Instructions for a Cash-Paying Patient: Submit this claim to Change Healthcare. A valid Other Coverage Code (eg, 1) is required. The card will cover up to a maximum of $250 for up to a 30-packet supply. 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.


Program managed by ConnectiveRx, on behalf of AstraZeneca.

READ NEXT: FAQs

ISI

What is the most important thing I should know about LOKELMA?

LOKELMA can cause swelling (edema) caused by fluid retention in your body (such as hands, ankles, feet).

  • LOKELMA contains 400 mg of sodium in each 5 g dose. Watch for signs of swelling in your body especially if you limit sodium in your diet or are likely to have fluid retention in your body due to heart or kidney problems. Your doctor may tell you to reduce the sodium in your diet.
  • If you are not on dialysis, your doctor may also tell you to increase the dose of your diuretic.

If you are a hemodialysis patient:

  • Do not take LOKELMA on dialysis days.
  • Tell your doctor if you suddenly feel sick such as decreased oral intake of food or fluids or diarrhea, as you may be at risk of developing low levels of potassium in your blood while on LOKELMA; therefore, your dose of LOKELMA may need to be adjusted.

What should I tell my doctor before taking LOKELMA?

Before taking LOKELMA, tell your doctor about all your medical conditions, including

  • problems having a bowel movement, including severe constipation, a blockage (obstruction) in your bowel, or dry hard stool that will not pass out of your rectum (impaction).
  • problems with your bowels after surgery.

What are the most common side effects with LOKELMA?

The most common side effect of LOKELMA is swelling in your body caused by fluid retention. Tell your doctor if you have any side effects that bother you or do not go away.

Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins and herbal supplements. LOKELMA may affect how some oral medicines work. Ask your doctor or pharmacist if you need to take LOKELMA 2 hours before or after other oral medicines.

APPROVED USE

LOKELMA is a prescription medication for the treatment of high levels of potassium in the blood (hyperkalemia) in adults.

Please see the full Prescribing Information for LOKELMA.

You may report side effects related to AstraZeneca products by clicking here.