All fields are required.

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I receive (or the person I care for receives) prescription coverage in whole or in part from Medicare, Medicaid, or another state or federally funded program.

Note: The BANZEL Savings Card is not available to patients enrolled in federal or state healthcare programs, including Medicare, Medicaid, Medigap, VA, DoD, or TRICARE.


Do you wish to receive information from BANZEL Connections? Information includes:

LGS, epilepsy, and seizure info

How to work with your
healthcare team

Treatment with BANZEL

Financial resources available to you

How to care for someone with LGS

Terms of Information Use

Please be advised that the personal information you provide will be used to satisfy your request to receive information about BANZEL. Eisai Inc. ("Eisai" or "we"), operates this website and our Privacy Policy will govern the collection, use, disclosure and retention of the information you provide here. Please do not submit any personal information unless you have read and agree with the terms of that Privacy Policy. Consistent with the Privacy Policy, we and our service providers may use the personal information you provide to contact you and send you communications, including about products and services that may interest you. By clicking the checkbox below, you agree that you have read, understand, and agree to these conditions.

In the event that I would like to opt out of receiving further communications, I can request that I be removed from the Eisai contact list at any time by clicking on the "Unsubscribe" link found at the bottom of all e-mail communications from Eisai.

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Return to registration form Sign up for support program

*Commercially insured patients pay the first $25 and Eisai Inc. will pay up to $275 per month. You could have additional financial responsibility depending on your insurance plan. Cash patients pay the first $25 and Eisai Inc. will pay up to $275 per month. For questions, please call 1-855-EISAI-4-U.

Banzel Savings Card Terms and Conditions: Good toward the purchase of BANZEL® prescriptions. Eligible patients pay the first $25 and Eisai Inc. will pay up to a maximum of $275 per month. No substitutions permitted. Save the Savings Card to reuse with each prescription. Not available to patients enrolled in federal or state healthcare programs, including Medicare, Medicaid, Medigap, VA, DoD, or TRICARE. Not valid for BANZEL® prescription reimbursed in full by any third-party payer. May not be combined with any other discount or offer. Federal law prohibits the selling, purchasing, trading, or counterfeiting of this card. Void outside the USA and where prohibited by law. Eisai Inc. reserves the right to rescind, revoke, or amend this offer without notice at any time. You must be 18 years or older to use the card for yourself or a minor. Patients and pharmacies are responsible for disclosing to insurance carriers the redemption and value of the Savings Card and complying with any other conditions imposed by insurance carriers, third-party payers, and applicable law on the redemption. The value of the Savings Card is not contingent on any prior or future purchases. This card may not be accepted at all pharmacies. This card is not an insurance program. No membership fees. This offer will expire July 31, 2021.