Financial Support Options
Helping eligible patients with access to therapy
RADICAVA ORS® recognized as a MAJOR CONTRIBUTION TO PATIENT CARE by the FDA.1 Request a rep visit.
Helping eligible patients with access to therapy
16,400+ people have been treated with RADICAVA ORS® (edaravone) or RADICAVA® (edaravone) IV2,a (see footnote) |
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Savings on their deductible, co-pay, and co-insurance costs for medication, and infusion costs, if applicableb (see footnote)
Annual re-enrollment; available to patients upon reverification of eligibility criteria
Personalized information enables submission of Pharmacy and Medical benefit claims
Start the process of checking your patient's health insurance coverage by completing a patient-signed Benefit Investigation and Enrollment Form (BIF).
You can provide information to eligible patients with commercial insurance by giving them the Out-of-Pocket Assistance Program Brochure for RADICAVA ORS® and RADICAVA® IV for Patients.
Learn how to submit a request for co-pay assistance and more with the Out-of-Pocket Assistance Program Brochure for RADICAVA ORS® and RADICAVA® IV.
If an eligible patient has paid out-of-pocket costs for RADICAVA® IV, give them the Request for Out-of-Pocket Assistance Reimbursement Form.
Out-of-Pocket Assistance Program Eligibility Requirements Updated May 2023.
The most recent eligibility requirement updates include:
If patients are over the age of 65, they may qualify for the program if they meet all other eligibility criteria
For RADICAVA ORS®: if patients have commercial prescription drug insurance and Medicare Part A (hospital benefit) and or Medicare Part B (medical benefit) they are eligible if they meet all other eligibility criteria
For RADICAVA® IV: if patients have commercial prescription drug insurance and Medicare Part A (hospital benefit) they are eligible if they meet all other eligibility criteria
RADICAVA ORS® | RADICAVA® IV | |
---|---|---|
Offer | As little as $0 | As little as $0 |
Annual Cap | $7,500 | $20,000 |
Age | 18+ | 18+ |
Residency | US or US Territories | US or US Territories |
Insurance Required | Commercial Prescription Coverage | Commercial Prescription Coverage |
Insurance Accepted | Medicare Part A Medicare Part B | Medicare Part A |
Insurance Not Accepted(Patients enrolled in these government programs are not eligible to participate) | Medicare Part C Medicare Part D Medicaid VA DoD Tricare Any other government insurance (state or federal) | Medicare Part B Medicare Part C Medicare Part D Medicaid VA DoD Tricare Any other government insurance (state or federal) |
Prescription Required? | Yes | Yes |
See full Eligibility Requirements & Terms and Conditions.
This is not insurance. The Out-of-Pocket Assistance Program is for eligible patients who have private, commercial health insurance with prescription coverage for RADICAVA ORS® or RADICAVA® IV which does not cover the entire cost of the medication. For RADICAVA ORS®, patients enrolled in commercial prescription drug insurance and Medicare Part A and/or Part B are eligible for assistance so long as they meet all other eligibility criteria and are not enrolled in or become enrolled in Medicare Parts C or D. For RADICAVA® IV, patients enrolled in commercial prescription drug insurance and Medicare Part A are eligible for assistance so long as they meet all other eligibility criteria and are not enrolled in or become enrolled in Medicare Parts B, C, or D. Support is not valid for patients covered, in whole or in part, by Medicaid, Department of Veterans Affairs (VA), Department of Defense (DoD), or any other federal or state health insurance program.
Other restrictions apply.
An Insurance & Access Specialist will reach out to the patient to help them understand the insurance and site-of-care selection process, if applicable, once you have prescribed RADICAVA ORS® (edaravone) or RADICAVA® (edaravone) IV and submitted a BIF with your patient’s signature to check your patient's health insurance coverage.
If eligible, the commercially insured patient will be enrolled in the Out-of-Pocket Assistance Program.c (see footnote)
Help investigate a patient's health insurance coverage and health plan benefits, as well as available RADICAVA® financial support options
Help patients understand how to access their prescribed medication, whether it's:
RADICAVA ORS® from a specialty pharmacy; or
RADICAVA® IV from an infusion therapy provider
Be available throughout the patient's treatment journey to help answer insurance- and access-related questions
For patients or caregivers of patients diagnosed with ALS, there may be government health plan options to consider. A JourneyMate Support Program™ Insurance & Access Specialist can help patients review information about government health plan options, including:
Medicare, Social Security Disability Insurance, and Medicaid
Medicare and Medicaid Dual Eligibility
Veterans Affairs, TRICARE, and DoD
Provide patients with information about their options with the Understanding Government Health Plan Options Brochure.
This brochure does not include a complete list or explanation of government health plans. Please visit HHS.gov for more information. A JourneyMate Support Program™ Insurance & Access Specialist can provide general information about these options.
Provide qualified Medicare Part D patients with information to help them understand how they may save on their prescription drugs with the Helpful Information About Medicare’s Low-Income Subsidy Brochure.
This brochure does not include a complete explanation of the program.
Important Medicare Part D Prescription Drug Coverage Changesd (see footnote):
Learn more by reviewing the Important Updates to Out-of-Pocket Medication Costs brochure.
Provide qualified Medicare Part D patients with the Important Updates to Your Out-of-Pocket Medication Costs brochure.
The Patient Assistance Program (PAP) can help patients in financial need who have no insurance and meet program eligibility requirements. Qualified patients may be able to receive RADICAVA ORS® or RADICAVA® IV at no charge.e (see footnote)
Provide patients with information about the PAP, including eligibility requirements and terms and conditions, with the Patient Assistance Program Brochure.
You can direct patients to these 3 resources that may provide help for them and their loved ones.
Mitsubishi Tanabe Pharma America, Inc. is not affiliated with these resource organizations, which may have their own eligibility criteria and evaluation processes. By listing these resource organizations, Mitsubishi Tanabe Pharma America, Inc. is not endorsing any particular service or group and is not responsible for the content of these sites or services. These resource organizations are provided here for informational purposes and are not meant to replace your healthcare provider's medical advice.
ALS Association Assistance Program
Healthwell
Foundation
The Assistance
Fund
Provide patients with information on coverage options for their treatment during the open enrollment period with the 2025 Open Enrollment Information for Patients.
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.
A JourneyMate Support Program™ Insurance & Access Specialist is provided by UBC on behalf of Mitsubishi Tanabe Pharma America, Inc. (MTPA). A JourneyMate Support Program™ Insurance & Access Specialist may provide information obtained from outside sources about a patient's insurance coverage, financial support options, and whether treatment is covered by their health plan. This information does not require a patient or their doctor to use any MTPA product. Because the information provided comes from outside sources, a JourneyMate Support Program™ Insurance & Access Specialist cannot guarantee the information will be accurate or complete.
aBased on RADICAVA ORS® and RADICAVA® IV prescriptions submitted in the US as of August 2024. Not independently verified. Return to content
bPersons residing in Massachusetts, Minnesota, Michigan, and Rhode Island are eligible for out-of-pocket assistance for the cost of the drug only and are not eligible for other types of cost support for administration of the medication. Return to content
cPatient signature on the Benefit Investigation and Enrollment Form or Patient Authorization Form is required to enable automatic enrollment in the Out-of-Pocket Assistance Program. Return to content
dPremiums vary by plan and patients are still responsible to pay their monthly premiums.7 Return to content
eEligibility Requirements & Terms and Conditions apply. Only the product provided at no charge. The Patient Assistance Program covers only the cost of RADICAVA ORS® or RADICAVA® IV and not the cost of any infusion services or healthcare provider visits, which are the sole responsibility of the patient. Return to content
References: 1. US Food and Drug Administration. Clinical superiority findings. Accessed April 11, 2024. https://www.fda.gov/industry/designating-orphan-product-drugs-and-biological-products/clinical-superiority-findings 2. Data on file. Jersey City, NJ: Mitsubishi Tanabe Pharma America, Inc. 3. Cubanski J, Neuman T. Changes to Medicare Part D in 2024 and 2025 Under the Inflation Reduction Act and How Enrollees Will Benefit. KFF website. Accessed January 2, 2024. https://www.kff.org/medicare/issue-brief/changes-to-medicare-part-d-in-2024-and-2025-under-the-inflation-reduction-act-and-how-enrollees-will-benefit 4. CMS Releases 2024 Advance Notice with Proposed Payment Updates for the Medicare Advantage and Part D Prescription Drug Programs. Centers for Medicare & Medicaid Services website. Accessed January 2, 2024. https://www.cms.gov/newsroom/press-releases/cms-releaes-2024-advance-notice-proposedpayment-updates-medicare-advantage-and-part-d-prescription 5. Hagan KL, Niles A. Addressing Rx Affordability. Pharmaceutical Commerce website. Accessed January 2, 2024. https://www.pharmaceuticalcommerce.com/view/addressing-rx-affordability 6. Cubanski J, Neuman T, Freed M. Explaining the Prescription Drug Provisions in the Inflation Reduction Act. KFF website. Accessed January 2, 2024. https://www.kff.org/medicare/issue-brief/explaining-the-prescription-drug-provisions-in-the-inflation-reduction-act/ 7. Sayed BA, Finegold K, Anders Olsen T, et al. Inflation Reduction Act Research Series—Medicare Part D Enrollee Out-Of-Pocket Spending: Recent Trends and Projected Impacts of the Inflation Reduction Act. US Department of Health and Human Services website. Accessed January 2, 2024. https://aspe.hhs.gov/sites/default/files/documents/93a68f3c5ca949dcf331aa0ec24dd46/aspe-part-doop.pdf
RADICAVA (edaravone) and RADICAVA ORS (edaravone) are contraindicated in patients with a history of hypersensitivity to edaravone or any of the inactive ingredients of this product. Hypersensitivity reactions (redness, wheals, and erythema multiforme) and cases of anaphylaxis (urticaria, decreased blood pressure, and dyspnea) have occurred with RADICAVA.
Patients should be monitored carefully for hypersensitivity reactions. If hypersensitivity reactions occur, discontinue RADICAVA or RADICAVA ORS, treat per standard of care, and monitor until the condition resolves.
RADICAVA and RADICAVA ORS contain sodium bisulfite, a sulfite that 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.
The most common adverse reactions (≥10%) reported in RADICAVA-treated patients were contusion (15%), gait disturbance (13%), and headache (10%). In an open label study, fatigue was also observed in 7.6% of patients receiving RADICAVA ORS.
Based on animal data, RADICAVA and RADICAVA ORS may cause fetal harm.
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.
RADICAVA and RADICAVA ORS are indicated for the treatment of amyotrophic lateral sclerosis (ALS).
Please see full Prescribing Information.
RADICAVA (edaravone) and RADICAVA ORS (edaravone) are contraindicated in patients with a history of hypersensitivity to edaravone or any of the inactive ingredients of this product. Hypersensitivity reactions (redness, wheals, and erythema multiforme) and cases of anaphylaxis (urticaria, decreased blood pressure, and dyspnea) have occurred with RADICAVA.
Patients should be monitored carefully for hypersensitivity reactions. If hypersensitivity reactions occur, discontinue RADICAVA or RADICAVA ORS, treat per standard of care, and monitor until the condition resolves.
RADICAVA and RADICAVA ORS contain sodium bisulfite, a sulfite that 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.
The most common adverse reactions (≥10%) reported in RADICAVA-treated patients were contusion (15%), gait disturbance (13%), and headache (10%). In an open label study, fatigue was also observed in 7.6% of patients receiving RADICAVA ORS.
Based on animal data, RADICAVA and RADICAVA ORS may cause fetal harm.
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.
RADICAVA and RADICAVA ORS are indicated for the treatment of amyotrophic lateral sclerosis (ALS).
Please see full Prescribing Information.
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