TO LEARN MORE ABOUT RADICAVA^®, SPEAK WITH A JOURNEYMATE RESOURCE SPECIALIST 1-855-457-6968. SEE MORE

RADICAVA ORS^®
Formulated to fit your life

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TO LEARN MORE ABOUT RADICAVA^®, SPEAK WITH A JOURNEYMATE RESOURCE SPECIALIST 1-855-457-6968. SEE MORE

How to Take RADICAVA ORS^® video

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The RADICAVA^® Educational Communication Series

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Resources

Starting Treatment

Steps on Your Way to Treatment Brochure

Use this brochure to help understand the steps you and your doctor may need to take for accessing treatment with RADIVACA ORS^® (edaravone) or RADICAVA^® (edaravone) IV. It also outlines the steps that may be required when switching from one form of RADICAVA^® to another.

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Receiving RADICAVA ORS^® From a Specialty Pharmacy

Use this information to better understand the steps to receiving your medication from a specialty pharmacy. It includes contact information for the in-network specialty pharmacies that may fulfill your prescription for RADICAVA ORS^®.

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Insurance Coverage

Requesting an Exception from Your Health Plan Information Sheet

The Requesting an Exception from Your Health Plan information sheet provides you with general information if your health insurance plan has denied coverage for RADICAVA ORS^® (edaravone) or RADICAVA^® (edaravone) IV. It also outlines general requirements that may be needed by your health insurance plan before a coverage determination can be made for RADICAVA ORS^® or RADICAVA^® IV. It provides a checklist of steps to fill out when working with your doctor to submit an exception or appeal to your health plan.

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Understanding Your Coverage and Costs for Treatment

This resource may help you understand your health insurance coverage and potential out-of-pocket costs for treatment with RADICAVA ORS^® or RADICAVA^® IV.

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Open Enrollment Brochure

The 2023 Open Enrollment Information for Patients brochure is designed to help you understand coverage options. This brochure does not include a complete list of health plan options.

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Understanding Government Health Plan Options Brochure

This brochure provides you with information about government health plan options that may be available.

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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.

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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.

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Financial Support

Low-Income Subsidy (LIS) Program Informational Brochure

Learn about a program to help qualified Medicare Part D patients save on their prescription drugs. This brochure does not include a complete explanation of the LIS program.

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Out-of-Pocket Assistance Program brochure for RADICAVA ORS^® and RADICAVA^® IV

The Out-of-Pocket Assistance Program for RADICAVA ORS^® or RADICAVA^® IV brochure provides information about the Out-of-Pocket Assistance Program for eligible patients with commercial insurance.

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Out-of-Pocket Assistance Program Enrollment Form

You may also apply to the Out-of-Pocket Assistance Program for RADICAVA ORS^® or RADICAVA^® IV by submitting the Out-of-Pocket Assistance Program Enrollment Form.

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Out-of-Pocket Assistance Reimbursement Form

Use this form if you are enrolled in the Out-of-Pocket Assistance Program and have already paid your out-of-pocket costs related to your treatment with RADICAVA^® IV. This form is only for use by patients treated with the IV formulation of RADICAVA^®.

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Financial Support Options Overview

Use this information sheet to help you navigate financial support options that may be available to help you cover applicable out-of-pocket costs associated with RADICAVA ORS^® or RADICAVA^® IV.

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Patient Assistance Program Brochure

The Patient Assistance Program Brochure allows you to learn about the Patient Assistance Program for uninsured patients who are in financial need and may qualify for the program.

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Learning about RADICAVA^® and Talking to Your Doctor

RADICAVA ORS^® Patient Brochure

This resource will help you learn about RADICAVA ORS^® as part of the care provided by your healthcare team and how you can communicate better with them.

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RADICAVA ORS^® Talk to Your Doctor Discussion Guide

Get useful information about talking to your doctor about RADICAVA ORS^®.

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RADICAVA ORS^® Caregiver Brochure

Helpful information for caregivers about this oral treatment.

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Patient Information

Review important information you should know about RADICAVA^®.

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Dosing and Administration

Dosing and Administration Guide

Review this helpful guide on when and how to take RADICAVA ORS^®.

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Starting Treatment

Benefit Investigation and Enrollment Form for RADICAVA ORS^® and RADICAVA^® IV

You or your doctor may download the Benefit Investigation and Enrollment Form (BIF) to prescribe RADICAVA ORS^® (edaravone) or RADICAVA^® (edaravone) IV and enroll you in the JourneyMate Support Program^™.

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Patient Authorization Form

Patient authorization is required to complete a BIF. If you have not already signed a BIF and would like to enroll in the JourneyMate Support Program^™, you may sign this form to enroll in JourneyMate Support Program^™ services. You can provide this authorization online or via mail, or fax.

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About RADICAVA^®

Prescribing Information

Review the full Prescribing Information for RADICAVA ORS^® and RADICAVA^® IV.

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Para usted

Información del paciente

Proporcione a los pacientes más información sobre cómo recibir
RADICAVA ORS^® (edaravone) y RADICAVA^® (edaravone) IV.

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Guía de administración y dosificación de RADICAVA ORS^® para el paciente

Obtenga orientación paso a paso para tomar RADICAVA ORS^®.

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Folleto sobre RADICAVA ORS^® para el paciente

Revise la información útil sobre este tratamiento oral.

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Instrucciones de uso de RADICAVA ORS^®

Revise las instrucciones para tomar RADICAVA ORS^®.

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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.

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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.

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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.

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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^®.

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Folleto sobre RADICAVA ORS^® para el cuidador

Información útil para cuidadores sobre este tratamiento oral.

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Para usted y su médico

Información de prescripción

Revise la información de prescripción para RADICAVA^®.

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Resources

Starting Treatment

Steps on Your Way to Treatment Brochure

Receiving RADICAVA ORS® From a Specialty Pharmacy

Insurance Coverage

Requesting an Exception from Your Health Plan Information Sheet

Understanding Your Coverage and Costs for Treatment

Open Enrollment Brochure

Understanding Government Health Plan Options Brochure

RADICAVA ORS® VA Formulary Brochure

RADICAVA® IV VA Formulary Brochure

Financial Support

Low-Income Subsidy (LIS) Program Informational Brochure

Out-of-Pocket Assistance Program brochure for RADICAVA ORS® and RADICAVA® IV

Out-of-Pocket Assistance Program Enrollment Form

Out-of-Pocket Assistance Reimbursement Form

Financial Support Options Overview

Patient Assistance Program Brochure

Learning about RADICAVA® and Talking to Your Doctor

RADICAVA ORS® Patient Brochure

RADICAVA ORS® Talk to Your Doctor Discussion Guide

RADICAVA ORS® Caregiver Brochure

Patient Information

Dosing and Administration

Dosing and Administration Guide

Starting Treatment

Benefit Investigation and Enrollment Form for RADICAVA ORS® and RADICAVA® IV

Patient Authorization Form

About RADICAVA®

Prescribing Information

Para usted

Información del paciente

Guía de administración y dosificación de RADICAVA ORS® para el paciente

Folleto sobre RADICAVA ORS® para el paciente

Instrucciones de uso de RADICAVA ORS®

Formulario de inscripción en el Programa de asistencia para gastos de bolsillo

Programa de asistencia para gastos de bolsillo folleto para RADICAVA ORS® y RADICAVA® IV

Formulario de autorización del paciente

Formulario de solicitud de reembolso de asistencia para gastos de bolsillo

Folleto sobre RADICAVA ORS® para el cuidador

Para usted y su médico

Información de prescripción

También están disponibles estos útiles videos en español.

Important Safety Information

Important Safety Information

You are now leaving Radicava.com

Receiving RADICAVA ORS^® From a Specialty Pharmacy

RADICAVA ORS^® VA Formulary Brochure

RADICAVA^® IV VA Formulary Brochure

Out-of-Pocket Assistance Program brochure for RADICAVA ORS^® and RADICAVA^® IV

Learning about RADICAVA^® and Talking to Your Doctor

RADICAVA ORS^® Patient Brochure

RADICAVA ORS^® Talk to Your Doctor Discussion Guide

RADICAVA ORS^® Caregiver Brochure

Benefit Investigation and Enrollment Form for RADICAVA ORS^® and RADICAVA^® IV

About RADICAVA^®

Guía de administración y dosificación de RADICAVA ORS^® para el paciente

Folleto sobre RADICAVA ORS^® para el paciente

Instrucciones de uso de RADICAVA ORS^®

Programa de asistencia para gastos de bolsillo folleto para RADICAVA ORS^® y RADICAVA^® IV

Folleto sobre RADICAVA ORS^® para el cuidador