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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TO LEARN MORE ABOUT RADICAVA®, SPEAK WITH A JOURNEYMATE RESOURCE SPECIALIST 1-855-457-6968. SEE MORE
TO LEARN MORE ABOUT RADICAVA®, SPEAK WITH A JOURNEYMATE RESOURCE SPECIALIST 1-855-457-6968. SEE MORE
TO LEARN MORE ABOUT RADICAVA®, SPEAK WITH A JOURNEYMATE RESOURCE SPECIALIST 1-855-457-6968. SEE MORE
TO LEARN MORE ABOUT RADICAVA®, SPEAK WITH A JOURNEYMATE RESOURCE SPECIALIST 1-855-457-6968. SEE MORE
TO LEARN MORE ABOUT RADICAVA®, SPEAK WITH A JOURNEYMATE RESOURCE SPECIALIST 1-855-457-6968. SEE MORE
TO LEARN MORE ABOUT RADICAVA®, SPEAK WITH A JOURNEYMATE RESOURCE SPECIALIST 1-855-457-6968. SEE MORE
TO LEARN MORE ABOUT RADICAVA®, SPEAK WITH A JOURNEYMATE RESOURCE SPECIALIST 1-855-457-6968. SEE MORE
Resources
Starting Treatment
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®.
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.
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.
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.
Understanding Government Health Plan Options Brochure
This brochure provides you with information about government health plan options that may be available.
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.
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.
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.
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.
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.
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®.
Financial Support Options Information Sheet
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.
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.
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.
RADICAVA ORS® Talk to Your Doctor Discussion Guide
Get useful information about talking to your doctor about RADICAVA ORS®.
RADICAVA ORS® Caregiver Brochure
Helpful information for caregivers about this oral treatment.
Dosing and Administration
Dosing and Administration Guide
Review this helpful guide on when and how to take RADICAVA ORS®.
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™.
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.
About RADICAVA®
Prescribing Information
Review the full Prescribing Information for RADICAVA ORS® and RADICAVA® IV.
Para usted
Información del paciente
Proporcione a los pacientes más información sobre cómo recibir
RADICAVA ORS® (edaravone) y RADICAVA® (edaravone) IV.
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®.
Folleto sobre RADICAVA ORS® para el cuidador
Información útil para cuidadores sobre este tratamiento oral.
Para usted y su médico
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