Out-of-Pocket Assistance Program
Support for eligible patients with commercial insurance
Patients who have commercial insurance coverage for treatment with
What eligible patients can expect:
- Savings on their deductible, co-pay, and co-insurance costs for their medication and infusion costs for
- Coverage of applicable out-of-pocket costs—up to $20,000 per calendar year
- Automatic re-enrollment for the next calendar year, if eligible
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
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.
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.
- 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.
At the time of treatment
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
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.
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.
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
If submitting a request by fax, please use the
Request for Co-payment Assistance Fax Cover Sheet
Make sure all required procedure and drug codes are clearly stated for treatment with
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.
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
Resources for uninsured patients
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
Restrictions apply. See
Enrolling your patients
- Complete the BIF and submit to Searchlight
Support®with all required documentation.
- 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
- Patients must reconfirm their eligibility for continued participation in the program after the initial 12-month eligibility period by providing required financial documentation.
- 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
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.