At Searchlight Support®, we’re here to help you navigate access to treatment with RADICAVA® for your patients.
Below, you will find instructions and information about some of the forms and processes you may need to complete or review to get patients started on or continue treatment with RADICAVA®.
Forms for Ordering RADICAVA®
To order RADICAVA®, you can download and submit the forms below.
Benefit Investigation and Enrollment Form
- Learn how to place an initial order for RADICAVA® and enroll patients in Searchlight Support®.
To request a benefit investigation and place an initial order for RADICAVA® for a patient, you must complete and submit a Benefit Investigation and Enrollment Form.
In addition to ordering RADICAVA® and starting the benefit investigation process, this form can enroll your patients in the
Searchlight Support®program. Once enrolled, patients will have access to services and assistance that may be available to them through Searchlight Support®. For eligible patients, this may include out-of-pocket cost support.
Following enrollment of your patient and assignment of a Searchlight Support® Patient ID, you may use an Order Form for Buy & Bill to place subsequent orders for RADICAVA® using the Patient ID.
Follow these steps to complete a Benefit Investigation and Enrollment Form:
Complete the required patient information for Searchlight Support®.
Provide proper insurance information or copy of patient’s insurance card(s).
Ask patient or their legally authorized representative to read and sign. Provide a copy of Patient Authorization Form to patient. If they are unavailable to sign this from, a Patient Authorization Form may be used.
Patient Financial Information
Complete patient financial information if patient has no insurance, or no insurance coverage for RADICAVA®.
Complete prescriber information section to ensure prompt communication with your office.
Provide the required prescription information for RADICAVA®. Check the box if you would like to acquire RADICAVA® through the specialty pharmacy.a Prescriber signature is required to process patient enrollment and validate prescription.
Preferred Site of Infusion
Indicate preferred site of infusion. Check the box to request infusion site-of-care location assistance and select an option: Primary, Secondary, or Both. Indicate days that apply to each location. Alternatively, provide information for the Primary and Secondary (if applicable) preferred site(s) of infusion. Include facility name, address, contact, and indicate days that apply to each location.
Following receipt of a completed Benefit Investigation and Enrollment Form, including all required information, Searchlight Support® will verify insurance benefits within 2 business days, advise if a prior authorization is required, provide your office with a benefit summary, and call the patient to discuss access and out-of-pocket cost support options.
aIf acquiring RADICAVA® through the specialty pharmacy provider, Searchlight Support® will coordinate assignment of benefits, order placements, and shipping instructions.
Restrictions apply. See Terms and Conditions.
- Patient Information
Patient Authorization Form
- See when this form is needed for Searchlight Support® enrollment.
If a patient or their legally authorized representative is not available to sign a Benefit Investigation and Enrollment Form, they may authorize Searchlight Support® services by submitting a Patient Authorization Form instead. This form is also available to patients on the RADICAVA.com patient website.
While patients may receive RADICAVA® without providing this authorization, they will not be able participate in or receive assistance from Searchlight Support®.
Let patients know that this authorization can be cancelled at any time. It will remain in effect for 5 years from the date of signature, or until a patient is no longer participating in Searchlight Support® services, whichever is sooner. Refer patients to the Patient Authorization Form for full terms and conditions.
For questions about patient authorizations for enrollment in Searchlight Support®, call
Buy and Bill Order Form
- Learn how to place subsequent orders for RADICAVA®.
After you have enrolled a patient in Searchlight Support® by completing a Benefit Investigation and Enrollment Form and a Patient ID has been assigned, you may place all subsequent orders for RADICAVA® using the Patient ID to complete an Order Form for Buy & Bill.
For questions about ordering RADICAVA®, call
You can submit your signed form by:
PO Box 2930
Phoenix, AZ 85062
HCP Resources to Access RADICAVA®
The tools and information provided below are available to help you and your office staff access
RADICAVA® for your patients. If you have questions or would like further assistance, call
Getting Started Checklist
Use this list to keep track of the steps you need to take to help your patients access treatment with RADICAVA®.
Sample Letter of Medical Necessity
This sample letter provides rationale for treatment with RADICAVA®. It can help you strengthen claims for treatment and appeals.
Final Benefit Summary
See an example of the information you will receive after submitting a Benefit Investigation and Enrollment Form.
- View more details about this summary
After you submit a Benefit Investigation and Enrollment Form and your patient’s insurance benefits have been verified, Searchlight Support® will provide your office with a comprehensive Final Benefit Summary within 2 business days. Below you will find information that a Final Benefit Summary may include.
Understanding Patient Benefits
Medical Coverage Detail
- Primary/Secondary/Tertiary plan coverage information
- Prior authorization requirements
- Deductible, out-of-pocket maximum, and patient co-pay/co-insurance
- Supporting documentation requirements
- Medication procurement options
- Coding requirements
Pharmacy Coverage Detail
- Primary/Secondary plan coverage information, as applicable (the information above plus pharmacy-specific benefits verification)
Medicare Part D Pharmacy Coverage Detail
- Payer/plan name information
- Year-to-date out-of-pocket phase status; deductible, initial coverage limit, coverage gap, catastrophic
Restrictions apply. See Terms and Conditions.
Prior Authorization Requests
We can assist with limited prior authorization (PA) support.
For questions about ordering or forms, call