Product Access Program
To learn more, call
We're here for you
Care Coordinator
Support for questions about general
health insurance coverage, navigating health plan benefits, and
ALS Care Locator
Enables you to locate ALS
care services, including infusion sites of care and home infusion services
Clinical Educator
Dedicated educational support and
information for patients who are being treated with
The Clinical Educator is an educational resource for patients who have been prescribed Radicava. All questions about your condition, diagnosis, or treatment should be referred to your healthcare provider.
How to enroll in Searchlight Support®
To be enrolled in Searchlight
- The form your HCP submits the first time they order
RADICAVA® for you (a Benefit Investigation and Enrollment Form), or - A separate Patient Authorization Form
3 ways to submit your signed Patient Authorization Forma
Electronically with DocuSign®
Access your Patient Authorization Form on your phone, tablet, or computer here. Simple prompts will guide you to read, electronically sign, and submit your form.
By Fax
Download, print, and sign your Patient Authorization Form (available here) and fax it to 1-888-782-6157. Searchlight
By Mail
Download, print, and sign your Patient Authorization Form (available here) and mail it to: SearchlightPO Box 2930
Phoenix, AZ 85062
If you have any questions about how to submit your signed form, call Searchlight
Once you are enrolled in Searchlight
The Understanding Support for Your Treatment brochure provides an overview of support services and resources for patients enrolled in Searchlight Support®. It includes information about the Searchlight Support® Out-of-Pocket Assistance Program and government-funded insurance coverage, as well as information for patients who may be uninsured.
aMitsubishi Tanabe Pharma America, Inc. ("MTPA") is not affiliated with DocuSign® or any electronic fax service providers (collectively, "service providers"). No fees or remuneration of any kind have been or will be exchanged with any healthcare provider for use of these service providers. Mention of these service providers does not constitute a referral, recommendation, endorsement of a particular service provider, and similarly, the absence of a service provider's name should not be construed as a negative comment from MTPA about that service provider. MTPA, as well as its employees or agents, shall not be held liable for any damages or harm resulting from any use or reliance on these service providers, and MTPA may modify its policy regarding these service providers at any time without notice.
bYour signature on the Benefit Investigation and
Enrollment Form is required to enable automatic enrollment in the Searchlight
Out-of-Pocket Cost Support Options
We understand that serious medical conditions place a financial burden on many families. That’s why Searchlight
Our dedicated Searchlight
Out-of-Pocket Assistance Program
Support for eligible patients with commercial insurance
If you meet the eligibility requirements and are otherwise eligible for treatment with
- Save on your deductible, co-pay, and co-insurance costs for your medication and infusion costsc
- Pay as little as $0 per infusion
- Your applicable out-of-pocket costs are covered–up to $20,000 per calendar yeard
- Annual re-enrollment, available upon reverification of commercial insurance benefits to confirm your continued eligibility for the program
- Program Card can be used with both your Pharmacy and Medical benefits
Assistance is not valid for patients covered, in whole or in part, by government health insurance (i.e., Medicare, Medicaid, VA, DoD, or other federal or state assistance programs). Other restrictions apply.
cPersons residing in Massachusetts, Minnesota, Michigan, and Rhode Island are eligible for out-of-pocket assistance for the cost of the drug only and are not eligible for other types of cost support for administration of the medication.
dYou will be responsible for any costs associated with
A program designed to help with treatment costs
Your personalized Program Card will be used by your infusion provider or specialty pharmacy to submit reimbursement claims to the Searchlight
IMPORTANT!
Please make sure to bring your Program Card to all your treatment appointments.
You can also use your card when a specialty pharmacy or home infusion provider calls to request payment of applicable out-of-pocket costs for your medication.
- How this program works
-
At enrollment, Searchlight
Support® will:- Review your insurance benefits to determine your out-of-pocket costs, and confirm your eligibility for the Program, including verifying commercial insurance
- Call to explain general insurance coverage options and out-of-pocket cost support options
- If eligible, send you a welcome letter with a Program Card
At time of treatment, your treatment provider will:
- Submit a claim for medication and infusion costsc to your primary health insurance plan
- Complete and submit a reimbursement claim for your applicable out-of-pocket costs using your Program Carde
Searchlight
Support® will issue payment to your infusion provider following validation of all required claim information, including the Explanation of Benefits (EOB) from your health plan.If your infusion provider does not participate in the Program, or if you've already paid your out-of-pocket costs related to your treatment: Complete and submit a Request for Out-of-Pocket Assistance Form, along with the required EOB and proof of payment/receipt for your out-of-pocket cost for
RADICAVA® . Call SearchlightSupport® for assistance.You may receive a check for applicable out-of-pocket costs following validation of all required claim information. Requests must be submitted within 365 days of the date of the EOB provided by your health plan.
eReimbursement claim for your applicable out-of-pocket costs will be submitted by your provider once they receive the EOB from your health plan.
Restrictions apply. See Eligibility Requirements & Terms and Conditions.
Out-of-Pocket Assistance Program Enrollment Form
Ask your healthcare provider if they have or will be submitting a Benefit Investigation and Enrollment Form for
Request for Out-of-Pocket Assistance Form
Use this form if you are enrolled in the Out-of-Pocket Assistance Program and have already paid your out-of-pocket costs to your infusion provider for costs related to your treatment or to a specialty pharmacy for the cost of
Information about Government Health Plan Options
If you or your loved one has been diagnosed with amyotrophic lateral sclerosis (ALS), there may be government health plan options to consider. Searchlight
- Medicare
- Social Security Disability Insurance
- Medicaid
- Medicare and Medicaid Dual Eligibility
- Veterans Administration
- TRICARE
- DoD
Resources for patients who are uninsured
The Searchlight
- How this program works
-
- You and your doctor complete the Benefit Investigation and Enrollment Form and submit to Searchlight
Support® . - Searchlight
Support® contacts you to verify that you do not have health insurance coverage, and to prequalify you based on your household size and income. If you prequalify, you will be asked to provide financial documentation to confirm that you meet all eligibility requirements. - If you meet the Patient Assistance Program requirements, the program covers your
RADICAVA® medication as prescribed by your doctor at no charge for one year.f - You must reconfirm your eligibility for continued participation in the program after your initial 12-month eligibility period, by providing required financial documentation.
- If you continue to meet the program requirements, you may be able to receive
RADICAVA® at no charge for an additional 12 months.
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 Eligibility Requirements & Terms and Conditions.
- You and your doctor complete the Benefit Investigation and Enrollment Form and submit to Searchlight
Alternate Support/Resource Information
Below, please find some resources that may provide more support for you and your loved ones.
Mitsubishi Tanabe Pharma America, Inc. is not affiliated with these resource organizations, which may have their own eligibility criteria and evaluation processes. By listing these resource organizations, Mitsubishi Tanabe Pharma America, Inc. is not endorsing any particular service or group and is not responsible for the content of these sites or services. These resource organizations are provided here for informational purposes and are not meant to replace your healthcare provider’s medical advice.
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ALS Association Assistance Program |
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Healthwell Foundation |
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Patient Services Incorporated (PSI) |
2021 Open Enrollment Information for Patients
The 2021 Open Enrollment Information for Patients brochure is designed to help you understand coverage options, even if infusions are received at multiple locations, such as at a doctor’s office, an infusion center, a hospital outpatient department, or at home. During Open Enrollment, you can review your insurance coverage and make changes, or you can choose a new plan. Since this brochure does not include a complete list of health plan options, please contact your health insurance company or medicare.gov for specific information.
To learn more, download the 2021 Open Enrollment Information for Patients brochure. If you have questions, please call Searchlight
ALS Care Locator
The ALS Care Locator is designed for the ALS community to help locate services for the treatment of ALS. It can help you:
- Search for infusion services capable of administering
RADICAVA® , including home infusion, based on your preferences; for example: - Type of facility, location, insurance accepted, including Medicare
- Languages spoken, hours of operation, amenities
- Find neurologists and other healthcare providers who treat ALS
Visit radicava.com/carelocator for more information, or to start a search now.g
The ALS Care Locator is an informational resource only regarding available treatment providers. The providers listed in the directory are under no obligation to provide treatment.
g The ALS Care Locator is a directory with a number of functions, including a directory of providers that treat ALS and which have opted-in to participate in the directory. This submission information is updated on a monthly basis.
Providers listed in the directory are not affiliated with Mitsubishi Tanabe Pharma America, Inc. and do not pay to be on this list. No fees or remuneration of any kind have been or will be exchanged for participation in the ALS Care Locator. Inclusion of a provider in the ALS Care Locator does not constitute a referral, recommendation, endorsement, or verification of credentials, qualifications, or abilities of the provider listed. Similarly, the absence of a provider's name and information should not be construed as a negative comment from Mitsubishi Tanabe Pharma America, Inc. about the provider's credentials, qualifications, or abilities.
Mitsubishi Tanabe Pharma America, Inc., as well as its employees or agents, shall not be held liable for any damages or harm resulting from any use or reliance on information contained in the ALS Care Locator; and may modify, amend, remove or cancel the ALS Care Locator at any time without notice.
If you are an HCP who treats ALS, including a neurologist and those at a multidisciplinary center, and would like to be added to the ALS Care Locator, please contact LocatorQuestions@mt-pharma-us.com, or if you would like to be removed from the ALS Care Locator, please contact LocatorOptOut@mt-pharma-us.com.
If you are an infusion service provider who has experience administering RADICAVA® and would like to be added to the ALS Care Locator, or if you are listed in the ALS Care Locator and would like to be removed, please contact Searchlight Support® at 1-844-SRCHLGT (1-844-772-4548).
Searchlight Support® FAQs
- Who can use Searchlight
Support® ? -
To help people with ALS access treatment with
RADICAVA® , SearchlightSupport® offers programs and assistance for healthcare providers and people who receiveRADICAVA® . Caregivers may also seek support on behalf of a loved one who receivesRADICAVA® .For questions about how Searchlight
Support® can help, call SearchlightSupport® at1-844-SRCHLGT (1-844-772-4548) . - How do I enroll for help from Searchlight
Support® ? To be enrolled in Searchlight
Support® , your healthcare provider must orderRADICAVA® for you. You will also need to sign a form to authorize your enrollment in the program.- Can I get help paying for
RADICAVA® ? -
Searchlight
Support® can give you information about out-of-pocket cost support programs and other sources of financial assistance that may be available to you.If you meet the eligibility requirements and are otherwise eligible for treatment with RADICAVA® (edaravone), you may be automatically enrolled when your healthcare provider submits a Benefit Investigation and Enrollment Form for
RADICAVA® which you have signed.b If you are in financial need and have no insurance, you may be eligible for the Patient Assistance Program.For questions about out-of-pocket cost support, call Searchlight
Support® at 1-844-SRCHLGT (1-844-772-4548). - What can I do if my insurance company denies coverage for
RADICAVA® ? -
Your insurance company may initially deny your treatment with
RADICAVA® . If this happens, you may be able to do something about it. Here are some ideas you may find helpful:-
Talk to your healthcare provider (HCP) and call your health plan to request an “exception” for coverage of your medication
If you have been notified that your medication is not covered by your health plan or that you need to meet other requirements before obtaining it, you can call your health plan and request an “exception” for coverage of your medication.
Review this guide for some helpful steps you may follow: Requesting an Exception from Your Health Plan.
-
Talk to your doctor to see if it may be possible to file an appeal
If your request for an exception is denied you may be able to appeal the decision.
Having your doctor file an appeal may help give your insurance provider more details about why you should receive treatment.
If the appeal does not work, your doctor may request a next-level appeal. Some of the people that may be involved include a panel of doctors, an administrative judge, or a local state representative.
-
Consider other insurance plan options
If you or or your loved one has been diagnosed with ALS, there may be government health plan options to consider. Regardless of age, people diagnosed with ALS can apply for Social Security Disability Insurance (SSDI) benefits, and subsequently, can apply for Medicare and/or Medicaid coverage.
For questions about appeals or insurance coverage, call Searchlight
Support® at 1-844-SRCHLGT (1-844-772-4548) to learn more.
-
Talk to your healthcare provider (HCP) and call your health plan to request an “exception” for coverage of your medication
- What can I do if I am denied infusion by a site of care?
If your preferred site of care is unable to accommodate you, our ALS Care Locator may help identify another infusion provider. Visit radicava.com/carelocator or call Searchlight Support® at 1-844-SRCHLGT (1-844-772-4548) to learn more.
- How do I renew my eligibility for out-of-pocket support into 2022?
You must re-enroll to remain in the Program in 2022. Verification of your insurance benefits is required to confirm that you continue to meet the eligibility requirements. To re-enroll, you must complete the Out-of-Pocket Assistance Program Enrollment Form and fax to 1-888-782-6157 or submit to Searchlight
Support® , PO Box 2930, Phoenix, AZ 85062.- What is DocuSign® and how do I use it with Searchlight Support®?
-
DocuSign® provides electronic signature technology and digital transaction management services to facilitate electronic exchange of contracts and signed documents.h,i
You or your Legal Representative have options for submitting a signed Patient Authorization Form to Searchlight Support®:
-
Your or your Legal Representative may access a link to the DocuSign® PowerForm
-
You or your Legal Representative can download, complete, and sign the Patient Authorization Form and submit by electronic fax, conventional fax, or USPS mail
hAs a reminder, all covered entities are obligated under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to have a business associate agreement (BAA) in place with any service provider that handles protected health information (PHI) on their behalf. This includes, among others, electronic data transmission services such as DocuSign® and electronic fax services. Please refer to each service provider’s website for more information regarding BAAs and PHI.
iMitsubishi Tanabe Pharma America, Inc. (“MTPA”) is not affiliated with DocuSign® or any electronic fax service providers (collectively, “service providers”). No fees or remuneration of any kind have been or will be exchanged with any healthcare provider for use of these service providers. Mention of these service providers does not constitute a referral, recommendation, endorsement of a particular service provider, and similarly, the absence of a service provider’s name should not be construed as a negative comment from MTPA about that service provider. MTPA, as well as its employees or agents, shall not be held liable for any damages or harm resulting from any use or reliance on these service providers, and MTPA may modify its policy regarding these service providers at any time without notice.
-
- Who can sign the Patient Authorization Form?
-
Either you or your Legal Representative can sign the DocuSign® Patient Authorization Form. If a Legal Representative is signing on your behalf, the Legal Representative completes the required fields on the form identifying the Legal Representative and their relationship to the patient.
The signer must identify themselves as either the “Patient” or “Legal Representative” and select the applicable checkbox on the DocuSign® form. DocuSign® will prompt the user to sign the applicable section based on how the user identifies themselves.
To learn more, call
The information and advice provided here are general in nature and are not intended to be a substitute for professional medical advice, diagnosis, or treatment. You are strongly encouraged to seek the advice of your doctor or other qualified healthcare provider with any questions regarding a medical condition.
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