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MEDICAL PRACTICE
REVIEW THE PIVOTAL STUDY DATA FOR RADICAVA® AND THE RESULTS FROM AN OBSERVATIONAL ANALYSIS FOR RADICAVA ORS® REVIEW NOW
Financial Support Options
Helping eligible patients with access to therapy
LOW out-of-pocket costs1-4
Your patients may have options to lower their medication costs1-4
With the Out-of-Pocket Savings Program, eligible commercial patients pay as little as $0 for RADICAVA ORS®1,a,b
- 96% of all prescriptions dispensed through the RADICAVA ORS® Out-of-Pocket Savings Program cost $0 in 20251,a,b
Medicare Part D patients pay a maximum of $2100/year for all prescription medications with the option to make set, monthly payments2,5
Uninsured patients who financially qualify can access RADICAVA ORS® through the Patient Assistance Program (PAP). Terms and conditions apply.
ALS is a 100% service-connected condition, so Veterans can access RADICAVA ORS® at no cost through the VA3,6,7
aFor eligible patients with commercial insurance. Annual maximum benefit per patient. Additional terms and conditions apply. See full Eligibility Requirements and Terms and Conditions.
bBased on claims prescriptions dispensed submitted to the Out-of-Pocket Savings Program from January 1, 2025 to November 12, 2025.
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The Out-of-Pocket Savings Program offers eligible patients with commercial insurance:
 | Patients pay as little as $0 per RADICAVA ORS® prescription dispense |
| | Applicable out-of-pocket costs are subject to a maximum annual benefit limit per calendar year |
| | Annual re-enrollment, available upon reverification of commercial insurance benefits and eligibility |
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 Savings Program Brochure for RADICAVA ORS® for Patients.
Learn how to submit a request for co-pay assistance, and more, with the Out-of-Pocket Savings Program Brochure for RADICAVA ORS®.
Out-of-Pocket Savings Program Eligibility Requirements
The most recent eligibility requirement updates include:
- Offer - Patient pays as little as $0
- Annual Cap - Maximum annual limit per calendar year applies
- Age - 18+
- Residency - US or US Territories
- Insurance Required - Commercial Prescription Coverage
- Insurance Allowed - Medicare Part A, Medicare Part B
- Insurance not Allowed (Patients enrolled in these goverment programs are not eligible to participate) - Medicare Part C, Medicare Part D, Medicaid, VA, DoD, Tricare, or any other government insurance (state or federal)
- Prescription Required? - Yes
See full Eligibility Requirements & Terms and Conditions.
This is not insurance. The Out-of-Pocket Savings Program is for eligible patients who have commercial insurance that covers a portion of the cost for RADICAVA ORS®. Support is not valid for patients covered, in whole or in part, by government-funded health insurance such as Medicare, Medicaid, VA, DoD, or other federal or state insurance programs. Other restrictions apply.
Your JourneyMate Support Program™ Insurance & Access Specialist will be ready to help patients
Once you have prescribed RADICAVA ORS® and submitted a Benefit Investigation and Enrollment Form (BIF) to check how your patient’s health insurance covers RADICAVA ORS®, an Insurance & Access Specialist will reach out to the patient to help them understand the insurance process.
If eligible, the commercially insured, patient will be contacted for enrollment in the Out-of-Pocket Savings Program.c (see footnote)
An Insurance & Access Specialist will:
Help investigate a patient’s health insurance coverage and health plan benefits, as well as the RADICAVA ORS® financial support options which may be available to patients if they meet all eligibility criteria
Help patients understand how to access RADICAVA ORS®
They are also available throughout the patient’s treatment journey to help answer insurance and access-related questions
For questions about the resources available for your patients and your practice, call an Insurance & Access Specialist at 1-844-772-4548. You can also fax: 1-888-782-6157.
Government Plan Patient Resources
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 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. 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.
How 2026 Updates May Impact Your Medicare Part D Patients' Costs
It's important for patients to contact their health insurance plan to verify their benefits.
This will give them the information they need to understand their total annual out-of-pocket cost.
- Changes that affect patients—including a cap on their OOP medication costs—will depend on their Medicare Part D plan
- Patients are still responsible for paying their monthly premium2
A new benefit verification needs to be run each year to determine new annual costs.
If patients are prescribed multiple medications, including more than one branded medication:
- Their co-pay for each medication will be based on the order they are submitted for payment up to their Part D out-of-pocket maximum
- After patients reach the out-of-pocket maximum, they won't face any additional out-of-pocket cost for their medications
If your patients have any questions about coverage or out-of-pocket costs, they should contact their health insurance representative or visit Medicare.gov.
Important Points to Know for 2026
- $2100 OOP prescription brand drug cost annual limit2
- Once patients reach this limit, they will pay $0 OOP for the rest of the year
- OOP costs are calculated based on patients’ Medicare Part D plan structure
- No more “coverage gap phase”2
- Patients will go directly from initial coverage into catastrophic coverage
- Medicare Prescription Payment Plan, also known as “smoothing”5
- Allows patients to enroll in a program to spread out-of-pocket cost payments for treatment over the year instead of paying all at once
Uninsured Patient Resource
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® at no charge.d (see footnote)
Provide patients with information about the PAP, including eligibility requirements and terms and conditions, with the Patient Assistance Program Brochure.
Alternate Support and Resources
You can direct patients to these 3 resources that may provide help for them and their loved ones.
Shionogi Inc. is not affiliated with these resource organizations, which may have their own eligibility criteria and evaluation processes. By listing these resource organizations, Shionogi 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
Open Enrollment for Patients
Provide patients with information on coverage options for their treatment during the open enrollment period with the 2026 Open Enrollment for Patients Brochure.
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 Shionogi Inc.. 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 Shionogi Inc. 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.
cPatient signature on the Benefit Investigation and Enrollment Form or Patient Authorization Form is required to enable automatic enrollment in the Out-of-Pocket Savings Program. Return to content
dEligibility Requirements & Terms and Conditions apply. Only the product provided at no charge. The Patient Assistance Program covers only the cost of RADICAVA ORS® and not the cost of any healthcare provider visits, which are the sole responsibility of the patient. Return to content
References: 1. Data on file. Shionogi Inc. 2. Cubanski J. KFF. A current snapshot of the Medicare Part D prescription drug benefit. Accessed May 15, 2026. https://www.kff.org/medicare/a-current-snapshot-of-the-medicare-part-d-prescription-drug-benefit 3. Current Veterans disability compensation rates. US Department of Veterans Affairs. Updated December 2, 2025. Accessed May 15, 2026. https://www.va.gov/disability/compensation-rates/veteran-rates 4. What are Medicare Savings Programs (MSPs)? National Council on Aging. Accessed on May 15, 2026. https://www.ncoa.org/article/what-are-medicare-savings-programs-msps 5. Hagan KL, Niles A. Addressing Rx affordability. Pharmaceutical Commerce. Accessed May 15, 2026. https://www.pharmaceuticalcommerce.com/view/addressing-rx-affordability 6. VA makes specially adaptive housing grant eligibility automatic for veterans and servicemembers living with ALS [news release]. US Department of Veterans Affairs. Published March 19, 2014. Accessed May 15, 2026. https://www.va.gov/opa/pressrel/pressrelease.cfm?id=2530 7. Can I get free healthcare and prescriptions as a Veteran? US Department of Veterans Affairs. VA.gov. Updated October 13, 2022. Accessed May 15, 2026. https://www.va.gov/resources/can-i-get-free-health-care-and-prescriptions-as-a-veteran
