Financial Support Options
Helping eligible patients with access to therapy
The Out-of-Pocket Assistance Program offers eligible patients with commercial insurance:
Savings on their deductible, co-pay, and co-insurance costs for medication, and infusion costs, if applicablea (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.
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|
|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
Any other government insurance (state or federal)
|Medicare Part B|
Medicare Part C
Medicare Part D
Any other government insurance (state or federal)
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.
A JourneyMate Support Program™ Insurance & Access Specialist will be ready to help patients
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.b (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 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, 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.
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® or RADICAVA® IV at no charge.c (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.
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.
Open Enrollment for Patients
Provide patients with information on coverage options for their treatment during the open enrollment period with the 2024 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.
aPersons 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
bPatient 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
cEligibility 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