Need resources and tools for each step
in the process?

Select and download resources for LEQVIO® or simply click the image to view now

Simply tap an image to view the resource

Select all resources below

GET STARTED

thumbnail image of LEQVIO Start Form

Start Form

thumbnail image of LEQVIO Start Form Spanish

Start Form -
Spanish

thumbnail image of Patient Consent Form

Patient Consent
Form

thumbnail image of Injection Guide

Injection Guide

thumbnail image of Injection Guide

Service Center
Portal Overview

GET INSURANCE COVERAGE INFORMATION

thumbnail image of Prior Authorization & Appeals Guide

Prior Authorization
& Appeals Guide

thumbnail image of Sample Letter of Medical Necessity

Letter of Medical Necessity Checklist

thumbnail image of Sample Letter of Medical Necessity

Sample Letter of Medical Necessity

thumbnail image of Letter of Medical Exception Checklist

Letter of Medical Exception Checklist

thumbnail image of Sample Letter of Medical Exception

Sample Letter of Medical Exception

thumbnail image of Letter of Medical Necessity Checklist

Letter of Appeal Checklist

thumbnail image of Sample Letter of Medical Necessity

Sample Letter of Appeal

GET FINANCIAL SUPPORT

thumbnail image of Copay Flashcard

Co-pay
Flashcard

thumbnail image of Co-pay Portal Overview

Co-pay Portal Overview

thumbnail image of Provider Commercial Copay Claim Form

Provider Commercial Co-pay Claim Form

thumbnail image of Specialty Pharmacy Commercial Co-pay Claim Form

Specialty Pharmacy Commercial Co-pay Claim Form

thumbnail image of Patient Pharmacy Claim Form

Patient Pharmacy Claim Form

GET PRODUCT

thumbnail image of Buy-and-Bill 5 Step Guide

Buy-and-Bill
5 Step Guide

thumbnail image of Buy-and-Bill Checklist

Buy-and-Bill Checklist

thumbnail image of Distribution & Product Acquisition Flashcard

Distribution & Acquisition
Flashcard

thumbnail image of Alternate Injection Center Referral Guide

Alternate Injection
Center Referral
Guide

thumbnail image of Alternate Injection Center Referral/Order Form

Alternate Injection
Center Referral/Order Form

thumbnail image of Alternate Injection Center Clinical Documentation Referral Checklist

Alternate Injection
Center Clinical
Documentation
Referral Checklist

thumbnail image of Alternate Injection Center Clinical Documentation Referral Checklist

LEQVIO Patient
Tracker

GET REIMBURSED

thumbnail image of Billing & Coding Guide

Billing & Coding
Guide

thumbnail image of Claims Filing Checklist

Permanent J-code
Flashcard

thumbnail image of Claims Filing Checklist

Claim Filing
Checklist

thumbnail image of Annotated CMS-1500 (UB-92) Form

Annotated
CMS-1500
Form

thumbnail image of Annotated CMS-1450 (UB-04) Form

Annotated
CMS-1450 (UB-04)
Form

Expand

Collapse

Up Arrow Down Arrow
IMPORTANT SAFETY INFORMATION

Adverse reactions in clinical trials (≥3% of patients treated with LEQVIO® and more frequently than placebo) were injection site reaction, arthralgia, urinary tract infection, diarrhea, bronchitis, pain in extremity and dyspnea.

Adverse reactions led to discontinuation in 2.5% and 1.9% of LEQVIO- and placebo-treated patients, respectively. Discontinuation due to injection site reactions, which included injection site pain, erythema and rash, were 0.2% and 0% of LEQVIO- and placebo-treated patients, respectively.

Please click here for LEQVIO full Prescribing Information.

INDICATION

LEQVIO (inclisiran) injection is indicated as an adjunct to diet and maximally tolerated statin therapy for the treatment of adults with clinical atherosclerotic cardiovascular disease (ASCVD) or heterozygous familial hypercholesterolemia (HeFH) who require additional lowering of low-density lipoprotein cholesterol (LDL-C). Limitations of Use: The effect of LEQVIO on cardiovascular morbidity and mortality has not been determined.

Please click here for LEQVIO full Prescribing Information.