LOKELMA has the best* branded formulary coverage in its class across commercial and Medicare Part D1

Complete Suite of Access & Affordability Services

  • Assistance with understanding patient insurance coverage
  • Prior authorization, claims, and appeal process support

LEARN MORE ABOUT MY LOKELMA SUPPORT PROGRAM

  • Savings Card for commercial patients
  • Free trial offer for all eligible patients

*“Best” is defined as covered lives (Commercial, Employer, FEHBP, Fed Prog, Municipal Plan, PBM, Union, EGWP, Medicare PDP, Medi-Medi, Medicare MA, Medicare SN, PACE) with a ≥5% advantage in Commercial and a ≥5% advantage in Medicare Part D over the competitor for formulary access based on the number of covered lives as calculated by Fingertip Formulary® as of 8/10/20. Branded Class includes LOKELMA and Veltassa® (patiromer) for oral suspension.

For commercially insured patients. Subject to eligibility. Restrictions apply.

Subject to eligibility. Restrictions apply.

Reference: 1. Formulary Data are provided by Fingertip Formulary and are current as of 8/10/20.

SAVINGS CARD

FREE TRIAL OFFER CARD

 

How the LOKELMA Savings Card works

Patients can begin saving with these 3 simple steps:

  • Have a prescription for LOKELMA.
  • Download a LOKELMA Savings Card.
  • Present the card with a prescription to the pharmacist.

    For Mail Order: Call the number on the card and ask for Customer Service, or click here to download the mail-in rebate form.

Eligibility requirements and terms of use

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 1-844-565-35621-844-565-3562.

By using this card, you and your pharmacist understand and agree to comply with these eligibility requirements and terms of use.

Insured/Covered Patients

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.

Insured/Not Covered Patients

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 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.

Cash-Paying Patient

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 1-800-433-48931-800-433-4893.

MY LOKELMA Support Program: helping patients access the care they need

The program offers many benefits to those who are starting or already taking LOKELMA, including:

For more information, please call the MY LOKELMA Support Program at 1-866-494-8080 1-866-494-8080

MY LOKELMA Support Program Enrollment Form & Appeal Resources

MY LOKELMA Support Program Enrollment Form

Enrollment Form

To get your patients started in the MY LOKELMA Support Program, download the Enrollment Form. Once completed, fax the form to 1-855-880-5258. 1-855-880-5258.

DOWNLOAD THE FORM

Medical Necessity Letter

Letter of Medical Necessity

If your patient's health plan requests a letter of medical necessity for prescribing LOKELMA, use this template when creating a response.

DOWNLOAD THE LETTER

LOKELMA Appeal Letter

Letter of Appeal

If the health plan has denied a prescription for LOKELMA, use this sample letter as a guide when drafting a response.

DOWNLOAD THE LETTER

Tier Exception

Tier Exception

If your patient’s health plan covers LOKELMA at a non-preferred tier, use this sample template as a guide to draft an exception request.

DOWNLOAD THE LETTER

Formulary/Plan Exclusion Exception Letter

Formulary/Plan Exclusion Exception

If LOKELMA is not on the formulary of your patient’s health plan, use this sample template as a guide to draft an exception request.

DOWNLOAD THE LETTER

If you have any questions or would like to speak to a MY LOKELMA Specialist, call 1-866-494-8080, 1-866-494-8080, Monday - Friday, 8 AM - 8 PM ET.

Help your patients transition onto LOKELMA treatment

DOWNLOAD BROCHURE

IMPORTANT SAFETY INFORMATION FOR LOKELMA® (sodium zirconium cyclosilicate)

WARNINGS AND PRECAUTIONS:

  • Gastrointestinal Adverse Events in Patients with Motility Disorders: Avoid LOKELMA in patients with severe constipation, bowel obstruction or impaction, including abnormal post-operative bowel motility disorders. LOKELMA has not been studied in patients with these conditions and it may be ineffective and may worsen gastrointestinal conditions.
  • Edema: Each 5-g dose of LOKELMA contains approximately 400 mg of sodium, but the extent of absorption by the patient is unknown. In clinical trials of LOKELMA in patients who were not on dialysis, edema was observed and was generally mild to moderate in severity and was more commonly seen in patients treated with 15 g once daily. Monitor for signs of edema, particularly in patients who should restrict their sodium intake or are prone to fluid overload (eg, heart failure or renal disease). Advise patients to adjust dietary sodium, if appropriate. Increase the dose of diuretics as needed.
  • In a clinical trial of LOKELMA in patients on chronic hemodialysis in which most patients were treated with doses of 5 g to 10 g once daily on non-dialysis days, there was no difference in the mean change from baseline in interdialytic weight gain (a measure of fluid retention) between the LOKELMA and placebo groups.
  • Hypokalemia in Patients on Hemodialysis: Patients on hemodialysis may be prone to acute illness that can increase the risk of hypokalemia on LOKELMA (eg, illnesses associated with decreased oral intake, diarrhea). Consider adjusting LOKELMA dose based on potassium levels in these settings.

ADVERSE REACTIONS: The most common adverse reaction in non-dialysis patients with LOKELMA was mild to moderate edema. In placebo-controlled trials up to 28 days, edema was reported in 4.4%, 5.9%, 16.1% of non-dialysis patients treated with 5 g, 10 g, and 15 g of LOKELMA once daily, respectively vs 2.4% of non-dialysis patients receiving placebo.

DRUG INTERACTIONS: LOKELMA can transiently increase gastric pH. In general, oral medications with pH-dependent solubility should be administered at least 2 hours before or 2 hours after LOKELMA. Spacing is not needed if it has been determined the concomitant medication does not exhibit pH-dependent solubility.

INDICATION AND LIMITATION OF USE:

LOKELMA is indicated for the treatment of hyperkalemia in adults.

LOKELMA should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action.

DOSING

  • Non-hemodialysis Patients
    For initial treatment of hyperkalemia, the recommended starting dose is 10 g administered three times a day up to 48 hours. For maintenance treatment, the recommended starting dose is 10 g once daily. Monitor serum potassium and adjust dose of LOKELMA at 1-week intervals or longer in increments of 5 g based on serum potassium and desired target range. The recommended maintenance dose range is from 5 g every other day to 15 g daily. Discontinue or decrease the dose of LOKELMA if serum potassium is below the desired target range.
  • Hemodialysis Patients
    For patients on chronic hemodialysis, administer LOKELMA only on non‑dialysis days. The recommended starting dose is 5 g once daily on non-dialysis days. Consider a starting dose of 10 g once daily on non-dialysis days in patients with serum potassium greater than 6.5 mEq/L. Monitor serum potassium and adjust the dose of LOKELMA based on the pre-dialysis serum potassium value after the long interdialytic interval and desired target range. During initiation and after dose adjustment, assess serum potassium after one week. Discontinue or decrease the dose of LOKELMA if serum potassium falls below the desired target range based on pre-dialysis value after the long interdialytic interval or the patient develops clinically significant hypokalemia. The recommended maintenance dose range is from 5 g to 15 g once daily, on non-dialysis days.

Please read full Prescribing Information for LOKELMA.

IMPORTANT SAFETY INFORMATION FOR LOKELMA® (sodium zirconium cyclosilicate)

WARNINGS AND PRECAUTIONS:

  • Gastrointestinal Adverse Events in Patients with Motility Disorders: Avoid LOKELMA in patients with severe constipation, bowel obstruction or impaction, including abnormal post-operative bowel motility disorders. LOKELMA has not been studied in patients with these conditions and it may be ineffective and may worsen gastrointestinal conditions.
  • Edema: Each 5-g dose of LOKELMA contains approximately 400 mg of sodium, but the extent of absorption by the patient is unknown. In clinical trials of LOKELMA in patients who were not on dialysis, edema was observed and was generally mild to moderate in severity and was more commonly seen in patients treated with 15 g once daily. Monitor for signs of edema, particularly in patients who should restrict their sodium intake or are prone to fluid overload (eg, heart failure or renal disease). Advise patients to adjust dietary sodium, if appropriate. Increase the dose of diuretics as needed.
  • In a clinical trial of LOKELMA in patients on chronic hemodialysis in which most patients were treated with doses of 5 g to 10 g once daily on non-dialysis days, there was no difference in the mean change from baseline in interdialytic weight gain (a measure of fluid retention) between the LOKELMA and placebo groups.
  • Hypokalemia in Patients on Hemodialysis: Patients on hemodialysis may be prone to acute illness that can increase the risk of hypokalemia on LOKELMA (eg, illnesses associated with decreased oral intake, diarrhea). Consider adjusting LOKELMA dose based on potassium levels in these settings.

ADVERSE REACTIONS: The most common adverse reaction in non-dialysis patients with LOKELMA was mild to moderate edema. In placebo-controlled trials up to 28 days, edema was reported in 4.4%, 5.9%, 16.1% of non-dialysis patients treated with 5 g, 10 g, and 15 g of LOKELMA once daily, respectively vs 2.4% of non-dialysis patients receiving placebo.

DRUG INTERACTIONS: LOKELMA can transiently increase gastric pH. In general, oral medications with pH-dependent solubility should be administered at least 2 hours before or 2 hours after LOKELMA. Spacing is not needed if it has been determined the concomitant medication does not exhibit pH-dependent solubility.

INDICATION AND LIMITATION OF USE

LOKELMA is indicated for the treatment of hyperkalemia in adults.

LOKELMA should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action.

DOSING

  • Non-hemodialysis Patients
    For initial treatment of hyperkalemia, the recommended starting dose is 10 g administered three times a day up to 48 hours. For maintenance treatment, the recommended starting dose is 10 g once daily. Monitor serum potassium and adjust dose of LOKELMA at 1-week intervals or longer in increments of 5 g based on serum potassium and desired target range. The recommended maintenance dose range is from 5 g every other day to 15 g daily. Discontinue or decrease the dose of LOKELMA if serum potassium is below the desired target range.
  • Hemodialysis Patients
    For patients on chronic hemodialysis, administer LOKELMA only on non‑dialysis days. The recommended starting dose is 5 g once daily on non-dialysis days. Consider a starting dose of 10 g once daily on non-dialysis days in patients with serum potassium greater than 6.5 mEq/L. Monitor serum potassium and adjust the dose of LOKELMA based on the pre-dialysis serum potassium value after the long interdialytic interval and desired target range. During initiation and after dose adjustment, assess serum potassium after one week. Discontinue or decrease the dose of LOKELMA if serum potassium falls below the desired target range based on pre-dialysis value after the long interdialytic interval or the patient develops clinically significant hypokalemia. The recommended maintenance dose range is from 5 g to 15 g once daily, on non-dialysis days.

Please read full Prescribing Information for LOKELMA.