This user guide provides step-by-step navigation of the HCP Portal, where you can enroll RADICAVA ORS® or RADICAVA® IV patients in the JourneyMate Support Program™and access updates and information for patients who provided authorization.
RADICAVA ORS® recognized as a MAJOR CONTRIBUTION TO PATIENT CARE by the FDA.1 Request a rep visit.
Resources
Get useful tools in English & Spanish for your office and patients.
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Starting RADICAVA ORS® (edaravone) or RADICAVA® (edaravone) IV
HCP Portal User Guide
Benefit Investigation and Enrollment Form for RADICAVA ORS® and RADICAVA® IV
Download the Benefit Investigation and Enrollment Form (BIF) to prescribe RADICAVA ORS® or RADICAVA® IV and enroll patients in the JourneyMate Support Program™.
Example Treatment Initiation Checklist for RADICAVA ORS®
Use this checklist to facilitate a common understanding of the steps involved in coordinating treatment initiation for RADICAVA ORS®.
Accessing RADICAVA ORS® Through a Specialty Pharmacy
RADICAVA ORS® is only available through an in-network pharmacy. This flashcard provides information about how the specialty pharmacy provides RADICAVA ORS® to patients and includes contact information for the specialty pharmacies.
Example Treatment Initiation Checklist for RADICAVA® IV
Use this checklist to facilitate a common understanding of the steps involved in coordinating treatment initiation for RADICAVA® IV.
Order Form for Buy & Bill for RADICAVA® IV
Learn how to place subsequent orders for RADICAVA® IV only.
Access and Coverage
Sample Appeal Letter
This letter may be considered if your patient’s request for an exception is denied.
Sample Exceptions Letter
This letter may be considered if your patient’s coverage is denied because the prescribed medication is not on your patient’s health plan formulary, or for another reason.
Coverage Determination Considerations for RADICAVA ORS®
Outlines documentation that may be required for the Prior Authorization process and the importance of providing this information to your patient’s health plan.
Financial Support
Financial Support Options Overview
Use with your patients to help them navigate options that may be available to them to help cover applicable out-of-pocket costs associated with their prescribed RADICAVA ORS® or RADICAVA® IV medication.
Out-of-Pocket Assistance Program Brochure for RADICAVA ORS® and RADICAVA® IV for HCPs
Learn more about the Out-of-Pocket Assistance Program for RADICAVA ORS® and RADICAVA® IV for your patients.
About RADICAVA®
RADICAVA ORS® The Difference is Experience Clinical History Brochure
Review the history of clinical and real-world experience that supports RADICAVA ORS® treatment—the ONLY FDA-approved oral form of edaravone.
Preparing the Infusion Bag Flashcard
Download a reminder of the steps to properly prepare the infusion bag.
Prescribing Information
Review the Prescribing Information for RADICAVA®.
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
Starting Treatment
Receiving RADICAVA ORS® From a Specialty Pharmacy
Patients can use this information to better understand the steps to receiving their medication from a specialty pharmacy. It includes contact information for the in-network specialty pharmacies that may fulfill their prescription for RADICAVA ORS® (edaravone).
RADICAVA ORS® Starter and Maintenance Dose
Helpful information on what you can expect when you receive your RADICAVA ORS® shipments, including contents of the Starter Kit and Maintenance Kit, and details about taking RADICAVA ORS®.
Steps on Your Way to Treatment Brochure
Patients can use this brochure to learn about the different formulations of edaravone and the steps to starting or switching treatments.
Insurance Coverage
Understanding Your Coverage and Costs for Treatment
Help patients understand their health insurance coverage and potential out-of-pocket costs for treatment with RADICAVA ORS® or RADICAVA® (edaravone) IV.
2025 Open Enrollment Information for Patients Brochure
Help patients understand their coverage options. This brochure does not include a complete list of health plan options.
Understanding Government Health Plan Options Brochure
Provide patients with information about government health plan options that may be available.
Patient Authorization Form
Patient authorization is required to complete a BIF. Patients can provide this authorization online or via mail, fax, or electronic fax.
RADICAVA ORS® VA Formulary Brochure
This resource helps patients understand that RADICAVA ORS® is on the VA National Formulary. It also provides information about treatment eligibility, benefit access, and other resources for veterans.2
RADICAVA® IV VA Formulary Brochure
This resource helps patients understand that RADICAVA® IV is on the VA National Formulary. It also provides information about treatment eligibility, benefit access, and other resources for veterans.2
Financial Support
Low-Income Subsidy (LIS) Program Information for Patients Brochure
This brochure is designed to help qualified Medicare Part D patients understand how they may be able to save on their prescription drugs with the LIS Program. This brochure does not include a complete explanation of the program.
Patient Assistance Program Brochure
Learn about the Patient Assistance Program for uninsured patients who are in financial need.
Out-of-Pocket Assistance Program Brochure for RADICAVA ORS® and RADICAVA® IV for Patients
Provide information about the Out-of-Pocket Assistance Program for RADICAVA ORS® and RADICAVA® IV for eligible patients with commercial insurance.
Out-of-Pocket Assistance Program Enrollment Form
Patients can complete and submit this form to the JourneyMate Support Program™ Insurance & Access Specialist to enroll in the Out-of-Pocket Assistance Program.
Educational Resources
RADICAVA ORS® Built on Solid Ground Clinical History Brochure
Share this brochure with patient to educate them on the history of clinical and real-world experience that supports RADICAVA ORS® treatment - the ONLY FDA-approved oral form of edaravone.
RADICAVA ORS® Patient Brochure
This resource will improve your patients' and caregivers' understanding about RADICAVA ORS® as well as the treatment and care that is extended by you and your team.
RADICAVA ORS® Caregiver Brochure
Helpful information for caregivers about this oral treatment.
Patient Information
Provide patients with more information about receiving RADICAVA ORS® and RADICAVA® IV.
Dosing and Administration
Dosing and Administration Guide
This guide helps patients understand when and how to take RADICAVA ORS®.
Instructions for Use
Review these step-by-step instructions on taking RADICAVA ORS®.
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. US Department of Veterans Affairs. Pharmacy benefits management services. Search: edaravone. Accessed July 25, 2022. https://www.pbm.va.gov/apps/VANationalFormulary/
Para consultorio y pacientes
Información de prescripción
Revise la información de prescripción para RADICAVA® (edaravone).
Para pacientes
Información del paciente
Proporcione a los pacientes más información sobre cómo recibir RADICAVA ORS® (edaravone) y RADICAVA® IV.
Instrucciones de uso de RADICAVA ORS®
Revise las instrucciones para tomar RADICAVA ORS®.
Folleto sobre RADICAVA ORS® para el paciente
Revise la información útil sobre este tratamiento oral.
Guía de administración y dosificación de RADICAVA ORS® para el paciente
Obtenga orientación paso a paso para tomar RADICAVA ORS®.
Programa de asistencia para gastos de bolsillo folleto para RADICAVA ORS® y RADICAVA® IV
El folleto del Programa de Asistencia de Bolsillo para RADICAVA ORS® o RADICAVA® IV proporciona información sobre el Programa de Asistencia de Bolsillo para pacientes elegibles con seguro comercial.
Formulario de inscripción en el Programa de asistencia para gastos de bolsillo
También puede solicitar el Programa de Asistencia de Bolsillo para RADICAVA ORS® o RADICAVA® IV presentando el Formulario de Inscripción en el Programa de Asistencia de Bolsillo.
Formulario de solicitud de reembolso de asistencia para gastos de bolsillo
Utilice este formulario si está inscrito en el Programa de Asistencia de Bolsillo y ya ha pagado sus gastos de bolsillo relacionados con su tratamiento con RADICAVA® IV Esta forma es para uso exclusivo en pacientes tratados con la formulación IV de RADICAVA®.
Formulario de autorización del paciente
Se requiere la autorización del paciente para completar un BIF. Si aún no ha firmado un BIF y desea inscribirse en el Programa de apoyo JourneyMate Support Program™, puede firmar este formulario para inscribirse en los servicios del Programa de apoyo JourneyMate Support Program™. Puede proporcionar esta autorización en línea o por correo postal, o por fax.
Los pacientes pueden acceder a estos útiles videos en español en el sitio web para pacientes que reciben RADICAVA®
