Accessing Treatment

Searchlight Support® can help you and your patients navigate options that may be available to help cover applicable out-of-pocket costs associated with RADICAVA® (edaravone).

For Insured Patients

Out-of-Pocket Assistance Program

Support for eligible patients with commercial insurance

Patients who have commercial insurance coverage for treatment with RADICAVA® may be eligible.

What eligible patients can expect:

  • Savings on their deductible, co-pay, and co-insurance costs for their medication and infusion costs for RADICAVA®
  • Coverage of applicable out-of-pocket costs—up to $20,000 per calendar year
  • Automatic re-enrollment for the next calendar year, if eligible
RADICAVA® (edaravone) Out-of-Pocket Assistance Program. Eligible patients pay as little as $0 per infusion
RADICAVA® (edaravone) Out-of-Pocket Assistance Program HCP brochure. Eligible patients pay as little as $0 per infusion

Out-of-Pocket Assistance Program Brochure for HCPs

Download
RADICAVA® (edaravone) Out-of-Pocket Assistance Program patient brochure. Eligible patients pay as little as $0 per infusion

Out-of-Pocket Assistance Brochure for Patients

Download

To learn more about the Out-of-Pocket Assistance Program, or to share with your patients, download the brochures above. Download the Affordability Options Flashcard to learn more about the options to help with out-of-pocket costs for your patients. This information is also available on the RADICAVA.com patient website.

Submitting a claim for reimbursement

Once you have received the primary Explanation of Benefits (EOB) from your patient's insurance provider, you can submit a claim to the Searchlight Support® Out-of-Pocket Assistance Program.

Restrictions apply. See

aRestrictions apply. $20,000 maximum program benefit per calendar year per eligibility criteria. See full Eligibility Requirements & Terms and Conditions for details.

bThe Searchlight Support® Out-of-Pocket Assistance Program is for eligible patients who have commercial insurance that covers a portion of the medication and administration costs for RADICAVA®.

Enrolling your patients

How patients get started in the Program:

The prescriber completes and submits the Benefit Investigation and Enrollment Form (BIF). Eligible patients are automatically enrolled in the Program. Patients may also enroll by completing the Out-of-Pocket Assistance Program Enrollment Form, available in the patient brochure.

Searchlight Support® will:

  • Verify the patient's commercial insurance benefits to confirm their eligibility
  • Call the patient to explain their insurance benefits for treatment with RADICAVA® and let them know they are automatically enrolled in the Program
  • Send the patient a welcome letter and brochure with a program card

Remind patients to always bring the program card to their treatment appointments.

copay card for the RADICAVA® (edaravone) out-of-pocket assistance highlighting patient ID and member ID

At the time of treatment

Request for Out-of-Pocket Assistance Program Enrollment Form

Download

Patients will provide their program card, which contains information required for submission of their request for co-payment assistance.

If the infusion provider cannot or does not participate in the Program, or if the patient has already paid for treatment with RADICAVA®, patients may submit a claim with a Request for Out-of-Pocket Assistance Form by mail to Searchlight Support®, 2250 Perimeter Park Drive, Suite 200, Morrisville, NC 27560, or fax to 1-844-695-9284.

Submitting a request for co-payment assistance

First, send a claim for medication and infusion costs to the patient's primary health plan. Then, complete a secondary claim request for co-payment assistance and submit it to the Program.

computer with claim on screen

Electronic Submission

Submit a standard electronic claim
to Interactive Medical Systems using Payer ID 56155, Group 00003635, and the patient’s Member ID as a secondary payer.

two pieces of paper, one with CMS 1500 and the other with UB-04

Mail or Fax Submission

Submit a medical claim form
(CMS-1500 or UB-04) and a copy of the primary health plan EOB.

Mail: PO Box 1349, Wake Forest, NC 27588
Fax: 1-919-562-0021

If submitting a request by fax, please use the
Request for Co-payment Assistance Fax Cover Sheet

Claim requirements

Make sure all required procedure and drug codes are clearly stated for treatment with RADICAVA®. Please include contact information in case there are any questions about the submission.

Payment for applicable out-of-pocket costs will be issued promptly following validation of all required out-of-pocket claim information. You will receive reimbursement for approved out-of-pocket assistance claims the same way you receive primary insurance payments.

The Program will not provide patient reimbursement about the wholesale acquisition cost (WAC) price.

Please note that claims must be submitted within 365 days of the date listed on the EOB received from the patient's primary insurance company.

If RADICAVA® is obtained under the patient's pharmacy benefit

Submit a request for co-payment assistance for out-of-pocket infusion administration costs as outlined above, including the EOB and the payer invoice. Co-pay funds are not available until the primary payer EOB is submitted as noted above. The patient will submit a claim for out-of-pocket medication costs to the Program.

For help processing a request for co-payment assistance, call 1-844-SRCHLGT (1-844-772-4548)

For Uninsured Patients

Resources for uninsured patients

 (edaravone) patient assistance program brochure

Patient Assistance Program Brochure

Download

The Searchlight Support® Patient Assistance Program (PAP) can help patients in financial need who are uninsured. Patients who meet Program requirements may be able to receive medication at no charge for up to 2 years.c The patient must be a citizen or permanent resident of the US or its territories, and reside in the US or its territories. The patient's income must not exceed 5 times the Federal Poverty Level based on household size (Federal Poverty Level Guidelines are available at https://aspe.hhs.gov/poverty-guidelines).

This information is also available on the RADICAVA.com patient website.

cOnly product provided at no charge. The Patient Assistance Program covers only the cost of RADICAVA® and not the cost of any infusion services or healthcare provider visits, which are the sole responsibility of the patient.

Restrictions apply. See

Enrolling your patients

  1. Complete the BIF and submit to Searchlight Support® with all required documentation.
  2. If a patient meets the Patient Assistance Program requirements, the program will cover their RADICAVA® medication as prescribed by you at no charge for 1 yeard
  3. Patients must reconfirm their eligibility for continued participation in the program after the initial 12-month eligibility period by providing required financial documentation.
  4. If a patient continues to meet the program requirements, they may be able to receive RADICAVA® at no charge for an additional 12 months.

dOnly the product provided at no charge. The Patient Assistance Program covers only the cost of RADICAVA® and not the cost of any infusion services or healthcare provider visits, which are the sole responsibility of the patient.

Open Enrollment

2021 open enrollment information for patients brochure

2021 Open Enrollment Information for Patients Brochure

Download

The 2021 Open Enrollment Information for Patients brochure is designed to help patients understand coverage options, even if infusion treatments are received at multiple locations, such as your office, infusion centers, a hospital outpatient department, or their homes. During Open Enrollment, patients can review their insurance coverage and make changes, or they can choose new plans. Since this brochure does not include a complete list of health plan options, patients should contact their health insurance companies or go to medicare.gov for specific information.

To learn more, download the 2021 Open Enrollment Information for Patients brochure. If you or your patients have questions, please call Searchlight Support® at 1-844-SRCHLGT (1-844-772-4548)

To learn more, call 1-844-SRCHLGT (1-844-772-4548)

▲ EXPAND▼ COLLAPSE

Important Safety Information

Hypersensitivity Reactions

Radicava® (edaravone) is contraindicated in patients with a history of hypersensitivity to edaravone or any of the inactive ingredients in Radicava®. Hypersensitivity reactions (redness, wheals, and erythema multiforme) and cases of anaphylaxis (urticaria, decreased blood pressure, and dyspnea) have been reported. Patients should be monitored carefully for hypersensitivity reactions, and if they occur, discontinue Radicava®, treat per standard of care, and monitor until the condition resolves.

Sulfite Allergic Reactions

Radicava® contains sodium bisulfite, and may cause allergic type reactions, including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in susceptible people. The overall prevalence of sulfite sensitivity in the general population is unknown, but occurs more frequently in asthmatic people.

Most Common Adverse Reactions

Most common adverse reactions (at least 10% and greater than placebo) are contusion, gait disturbance, and headache.

Pregnancy

Based on animal data, Radicava® may cause fetal harm.

Geriatric Use

No overall differences in safety or effectiveness were observed between patients 65 years of age and older and younger patients, but greater sensitivity of some older individuals cannot be ruled out.

To report suspected adverse reactions or product complaints, contact Mitsubishi Tanabe Pharma America, Inc., at 1-888-292-0058. You may also report suspected adverse reactions to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Indication

Radicava® is indicated for the treatment of amyotrophic lateral sclerosis (ALS).

Please see full Prescribing Information.

For more information about RADICAVA®, call 1-888-292-0058.