On-line Prescreening Tool

Welcome to the Eisai Patient Assistance Program (PAP) prescreening tool for healthcare professionals. The Eisai PAP provides Eisai medicines at no cost to financially needy patients who meet program eligibility criteria.

This prescreening tool is intended to assist healthcare professionals in:
  • Determining if a patient may be eligible for the PAP
  • Pre-populating enrollment forms to be submitted for the PAP

The prescreening process is an initial step to determine if a patient may be eligible. A final enrollment determination will be made once a complete and signed enrollment form and prescription are submitted via fax.

To get started, click here
Please Call 1-866-613-4724

For medical inquires or to report an adverse event, call Medical Services at 1-888-274-2378.
For patient assistance information about Aricept®, Banzel® and Zonegran® 1-800-226-2072.

If you have any questions or would like assistance please do not hesitate to contact us at 1-(866) 613-4724. Program Specialists are available to assist you Monday through Friday between 8 AM and 8 PM Eastern Time.

  • Products
  • Halaven®
    (eribulin mesylate) injection
  • Aloxi®
    (palonosetron hydrochloride)