How to Help Your Patients Find Lokelma in Stock: A Provider's Guide

You've prescribed Lokelma (sodium zirconium cyclosilicate) for a patient with hyperkalemia. The clinical rationale is sound: rapid potassium reduction, good tolerability, and the ability to maintain RAASi therapy. But one week later, you find out your patient never started taking it—because they couldn't find it at their pharmacy.

Prescription abandonment is a well-documented problem for specialty medications, and Lokelma is no exception. This guide gives nephrologists, cardiologists, and primary care providers actionable steps to reduce that abandonment rate and ensure patients actually receive the medication they need.

Understanding Why Patients Abandon Lokelma Prescriptions

The barriers to Lokelma access fall into three broad categories:

1. Access/availability: Lokelma is a specialty drug not stocked at most retail pharmacies. Patients who go to a standard pharmacy chain are frequently told it's unavailable.
2. Insurance/prior authorization: Nearly all payers require prior authorization for Lokelma. Without a PA already in place, patients arrive at the pharmacy only to be turned away.
3. Cost: At $1,000+ per month retail, sticker shock at the pharmacy is a real deterrent, particularly for patients unaware of the AstraZeneca savings card.

Intervention 1: Route Prescriptions Directly to Specialty Pharmacies

The single most effective step you can take is sending Lokelma ePrescriptions directly to a specialty pharmacy rather than a patient's default retail pharmacy. Specialty pharmacies stock Lokelma reliably and are equipped to handle insurance coordination, prior authorization, and patient education.

Preferred specialty pharmacies for Lokelma:

• CVS Specialty: 1-800-237-2767; accepts ePrescriptions via Surescripts
• Walgreens Specialty: 1-877-694-2579; home delivery available nationwide
• Optum Specialty Pharmacy: Integrated with UHC/Optum-aligned plans; 1-855-427-4682
• Hospital-affiliated outpatient pharmacies: Ideal for patients already in your hospital system; 340B pricing available at qualifying institutions

Intervention 2: Initiate Prior Authorization at the Point of Prescribing

PA delays are one of the most common reasons Lokelma prescriptions aren't filled. To minimize delays:

• Submit PA at the same visit or hospital encounter you write the prescription
• Include serum potassium levels (date and value), RAASi agent(s) prescribed and their indication, comorbidities (CKD stage, LVEF if HF), and prior potassium binder trials
• For step therapy exceptions: document why SPS (Kayexalate) or patiromer is not appropriate (e.g., GI motility issues, magnesium depletion risk)
• Use AstraZeneca's hub (Lokelma Patient Support: 1-844-565-3562) for PA support and appeal assistance

Intervention 3: Inform Patients of the Lokelma Savings Card at the Visit

Many patients who receive a Lokelma prescription leave the visit without knowing about the manufacturer savings programs. Share this at the point of prescribing:

• Lokelma Savings Card: Eligible commercially insured patients pay as low as $0 per 30-packet supply (max savings $450 per fill, valid 12 months). Cash-paying patients save up to $250 per fill.
• AZ&Me Prescription Savings Program: For uninsured or underinsured patients who meet income criteria; call 1-800-292-6363 or visit azandme.com

Intervention 4: Recommend medfinder for Pharmacy Searches

For patients who end up filling at a retail pharmacy without specialty routing, or who live in areas with fewer specialty pharmacy options, consider recommending medfinder. medfinder calls pharmacies near a patient's location to check which ones have their medication in stock, then texts the results. This is especially useful when a patient reports they couldn't find it "anywhere nearby."

Intervention 5: Set Up Mail-Order for Ongoing Refills

Once a patient is established on Lokelma and their potassium is well-controlled, transitioning them to a 90-day mail-order supply through a specialty pharmacy removes the monthly access friction. Most plans allow this, and the copay per fill is typically lower. Documenting stable potassium on refill requests helps ensure continued PA approval.

Quick Provider Checklist for a Lokelma Prescription

• Send ePrescription to a specialty pharmacy (not the patient's default retail chain)
• Initiate prior authorization the same day; document RAASi indication and hyperkalemia history
• Provide or direct patient to the Lokelma Savings Card (lokelma.com)
• Counsel patient on medfinder if they have difficulty locating the medication
• Follow up within 2 weeks to confirm the prescription was filled and patient started treatment