Searchlight Support®

Searchlight Support® can help your practice and patients with education as well as out-of-pocket cost support, and Benefit Investigation and Enrollment assistance.

About the Program

We’re here for you and your patients

Searchlight Support® provides education and assistance for people who receive RADICAVA® (edaravone) and those who care for them. Our Care Coordinators are ready to talk.

We can support you and your office staff by providing limited prior authorization assistance, payer policy research for efficient claims submission, general coding and billing information, and support with the exceptions and appeals process.a

Restrictions apply. See

aEach healthcare provider is ultimately responsible for determining the appropriate codes, coverage, and payment for individual patients. Searchlight Support® does not guarantee third-party coverage or payment for RADICAVA® or reimburse for claims that are denied by third-party payers.

Get forms and resources to order RADICAVA® for your patients

To learn more, call 1-844-SRCHLGT (1-844-772-4548)

Resources available to you

For questions or more information, you can request a representative visit or call Searchlight Support® at 1-844-SRCHLGT (1-844-772-4548)

Benefit Investigation and Enrollment

To order RADICAVA® and conduct a benefit investigation for your patients, you will need to complete and submit a Benefit Investigation and Enrollment Form. In addition to ordering RADICAVA® and starting the benefit investigation process, this form can also enroll your patients in the Searchlight Support® program.b

Complete and submit a BIF

You will need to complete and sign the BIF and obtain the patient’s signature. Patients may have already completed Sections 1-4 as suggested on the RADICAVA.com patient website.

  • Use the button to download a BIF
  • Provide all required information
  • Make sure the patient has read and signed the Patient Authorization in Section 3
  • Fax or mail to Searchlight Support®
  • Fax: 1-888-782-6157 Mail: PO Box 2930, Phoenix, AZ 85062

Note: The information you enter in the BIF is not being stored, so make sure you save it.

benefit investigation and enrollment form (BIF) for RADICAVA® (edaravone), an FDA approved treatment option for ALS

Download a BIF

Download

For assistance or additional information, call Searchlight Support® at 1-844-SRCHLGT (1-844-772-4548) Monday-Friday, 8 AM to 8 PM.

Searchlight Support® willc:

  • Acknowledge receipt of the Benefit Investigation and Enrollment Form within 1 business day
  • Advise if a prior authorization is required, provide a concise benefit summary to your office and your patient, and offer limited prior authorization and appeals assistance within 2 business days
  • Offer streamlined product acquisition options through Buy & Bill (directly from our Limited Distribution Network) or specialty pharmacies (including assignment of medical benefit)

Let your patients know

After the enrollment process is complete, a Care Coordinator from Searchlight Support® will be assigned and can call your patients to help with:

bSearchlight Support® cannot enroll a patient in Searchlight Support® services without patient authorization, which can be found on the Benefit Investigation and Enrollment Form, or a separate signed Patient Authorization Form for RADICAVA® on file. In addition, a Searchlight Support® Benefit Investigation and Enrollment Form must be submitted for each patient for whom treatment with RADICAVA® is requested.

cFollowing receipt of a completed Benefit Investigation and Enrollment Form including all required information.

Restrictions apply. See

For questions or more information, you can request a representative visit or call Searchlight Support® at 1-844-SRCHLGT (1-844-772-4548)

Out-of-Pocket Cost Support

logo

Searchlight Support® can help you and your patients navigate options that may be available to help cover applicable out-of-pocket costs associated with RADICAVA®, if they are eligible.

The Affordability Options Flashcard is a convenient tool you can use with your patients.

flashcard for the affordability options for RADICAVA® (edaravone) to help cover applicable out-of-pocket costs

Affordability Options Flashcard

Download

Out-of-Pocket Assistance Program

Support for eligible patients with commercial insurance

Patients who have commercial insurance coverage for treatment with RADICAVA® may be eligible.

What eligible patients can expect:

  • Savings on their deductible, co-pay, and co-insurance costs for their medication and infusion costs for RADICAVA®
  • Applicable out-of-pocket costs are covered—up to $20,000 per calendar year
  • Patients will be automatically re-enrolled for the next calendar year, if eligible
RADICAVA® (edaravone) Out-of-Pocket Assistance Program. Eligible patients pay as little as $0 per infusion
RADICAVA® (edaravone) Out-of-Pocket Assistance Program HCP brochure. Eligible patients pay as little as $0 per infusion

Out-of-Pocket Assistance Program Brochure for HCPs

Download
RADICAVA® (edaravone) Out-of-Pocket Assistance Program patient brochure. Eligible patients pay as little as $0 per infusion

Out-of-Pocket Assistance Brochure for Patients

Download

To share information about the Out-of-Pocket Assistance Program with your patients, please download the Out-of-Pocket Assistance Program Brochure for 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 Support® Out-of-Pocket Assistance Program. To receive reimbursement, download and follow these instructions.

dRestrictions apply. $20,000 maximum program benefit per calendar year per eligibility criteria. See full Eligibility Requirements & Terms and Conditions for details.

eThe Searchlight Support® Out-of-Pocket Assistance Program is for eligible patients who have commercial insurance that covers a portion of the medication and administration costs for RADICAVA®.

Restrictions apply. See

How patients get started in the Program:

The prescriber completes and submits the Benefit Investigation and Enrollment Form. 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.

Searchlight Support® will:
  • 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
copay card for the RADICAVA® (edaravone) out-of-pocket assistance highlighting patient ID and member ID

Remind patients to always bring the program card to their treatment appointments.

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 RADICAVA®, patients may submit a claim with a Request for Out-of-Pocket Assistance Form by mail to Searchlight Support®, 2250 Perimeter Park Drive, Suite 200, Morrisville, NC 27560, or fax to 1-844-695-9284.

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.

computer with claim on screen

ELECTRONIC SUBMISSION

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.

two pieces of paper, one with CMS 1500 and the other with UB-04

MAIL OR FAX SUBMISSION

Submit a medical claim form (CMS-1500 or UB-04) and a copy of the primary health plan Explanation of Benefits (EOB).

Mail: PO Box 1349, Wake Forest, NC 27588  Fax: 1-919-562-0021

If submitting a request by fax, please use the Request for Co-payment Assistance Fax Cover Sheet.

fax cover sheet to request co-payment assistance for RADICAVA® (edaravone)

Request for Co-payment Assistance Fax Cover Sheet

Download

Claim requirements

Make sure all required procedure and drug codes are clearly stated for treatment with RADICAVA®. Please include contact information in case there are any questions about the submission.

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. View complete instructions for submitting a claim for reimbursement.

If 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 1-844-SRCHLGT (1-844-772-4548)

Resources for patients who are uninsured

The Searchlight Support® Patient Assistance Program (PAP) can help patients in financial need who are uninsured. Patients who meet Program requirements may be able to receive medication at no charge for up to 2 years.f The patient must be a citizen or permanent resident of the US or its territories, and reside in the US or its territories. The patient’s income must not exceed 5 times the Federal Poverty Level based on household size (Federal Poverty Level Guidelines are available at https://aspe.hhs.gov/poverty-guidelines).

RADICAVA® (edaravone) patient assistance program brochure

Patient Assistance Program Brochure

Download

To share this information with your patients, please download the Patient Assistance Program Brochure. This information is also available on the RADICAVA.com patient website.

fOnly product provided at no charge. The Patient Assistance Program covers only the cost of RADICAVA® and not the cost of any infusion services or healthcare provider visits, which are the sole responsibility of the patient.

Restrictions apply. See

  1. Complete the Benefit Investigation and Enrollment Form and submit to Searchlight Support® with all required documentation.
  2. 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 yearg
  3. Patients must reconfirm their eligibility for continued participation in the program after the initial 12-month eligibility period by providing required financial documentation.
  4. If a patient continues to meet the program requirements, they may be able to receive RADICAVA® at no charge for an additional 12 months.

gOnly the product provided at no charge. The Patient Assistance Program covers only the cost of RADICAVA® and not the cost of any infusion services or healthcare provider visits, which are the sole responsibility of the patient.

The 2020 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.

2020 open enrollment information for patients brochure

2020 Open Enrollment Information for Patients Brochure

Download

To learn more, download the 2020 Open Enrollment Information for Patients brochure. If you or your patients have questions, please call Searchlight Support® at 1-844-SRCHLGT (1-844-772-4548)

Searchlight Support® FAQs

To help navigate access to treatment with RADICAVA®, Searchlight Support® offers product access programs for healthcare providers and people who receive RADICAVA®. Caregivers may also seek support on behalf of a loved one who receives RADICAVA®.

For questions about the services available for your patients and your practice, call Searchlight Support® at 1-844-SRCHLGT (1-844-772-4548).

No. However, the Department of Veterans Affairs (VA) provides assistance and access to treatment options for veterans with ALS. This includes treatment with RADICAVA®, which is on the VA National Formulary subject to National Prior Authorization criteria. You can learn more about these services and accessing RADICAVA® for veterans here.

Yes. To arrange for a Rep to come to your office, sign up to request a visit.

At Searchlight Support®, we offer tools and services to help you navigate access to treatment for your patients.

Yes. A representative from Searchlight Support® can visit your practice to show you how to properly store and administer RADICAVA®.

To request a visit, you can sign up or call Searchlight Support® at 1-844-SRCHLGT (1-844-772-4548).

These topics are also discussed in the Administration Guide Video.

When you remove RADICAVA® from the carton, you will notice that the IV bags are protected by a secondary overwrap packaging that contains an oxygen absorber and an oxygen indicator. You should only use RADICAVA® if the indicator is pink prior to opening the overwrap packaging. This reflects appropriate oxygen levels.

However, if the indicator is blue or purple before the overwrap is opened, it means that the product was exposed to oxygen and should not be used.

For more information, watch the Administration Guide Video or call Searchlight Support® at 1-844-SRCHLGT (1-844-772-4548).

To return damaged or unused product, contact MTPA's Order/Returns Service at 1-844-529-8990.

Potential Adverse Event: Contact MTPA Medical Information at 1-888-292-0058 no later than one (1) business day of receipt of the information.

Review the Return Goods Policy

To learn more, call 1-844-SRCHLGT (1-844-772-4548)

▲ EXPAND▼ COLLAPSE

Important Safety Information

Hypersensitivity Reactions

Radicava® (edaravone) is contraindicated in patients with a history of hypersensitivity to edaravone or any of the inactive ingredients in Radicava®. Hypersensitivity reactions (redness, wheals, and erythema multiforme) and cases of anaphylaxis (urticaria, decreased blood pressure, and dyspnea) have been reported. Patients should be monitored carefully for hypersensitivity reactions, and if they occur, discontinue Radicava®, treat per standard of care, and monitor until the condition resolves.

Sulfite Allergic Reactions

Radicava® contains sodium bisulfite, and 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.

Most Common Adverse Reactions

Most common adverse reactions (at least 10% and greater than placebo) are contusion, gait disturbance, and headache.

Pregnancy

Based on animal data, Radicava® may cause fetal harm.

Geriatric Use

No overall differences in safety or effectiveness were observed between patients 65 years of age and older and younger patients, but greater sensitivity of some older individuals cannot be ruled out.

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.

Indication

Radicava® is indicated for the treatment of amyotrophic lateral sclerosis (ALS).

Please see full Prescribing Information.

For more information about RADICAVA®, call 1-888-292-0058.