The My LOKELMA Support Program team can also provide additional information if you are in need of financial assistance.
*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.
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
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).
If you are a hemodialysis patient:
What should I tell my doctor before taking LOKELMA?
Before taking LOKELMA, tell your doctor about all your medical conditions, including
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.
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.