Provider services

Current June 2026 form and EPS page identify enrollment, benefits verification and financial-assistance evaluation. The page offers prior-authorization and appeal information and Access and Reimbursement Manager support. Submit the completed form and requested insurance documents by the published fax; eligibility and payer decisions remain separate.

Current July 2026 form covers LEQEMBI infusion and LEQEMBI IQLIK with formulation-specific PAP, temporary supply and copay offerings. Select the appropriate sections and secure the required patient authorization. Current EPS page identifies LEQEMBI Companion and access/reimbursement support; enrollment does not assure coverage or program eligibility.

Operated by Sonexus Health Pharmacy Services, LLC; NPI 1861259194 and NCPDP 5942176 appear in current forms. LENVIMA EPS offers e-prescribing as an enrollment option. LEQEMBI form limits this pharmacy section to PAP and LEQEMBI infusion TSP evaluation. Use each product’s own form and fax; the pharmacy’s Suite 400A differs from Suite 300 authorization correspondence.