An EOB from patient’s private, commercial health insurance must be submitted within 365 days of the date of service on the EOB for patient to receive out-of-pocket assistance benefit.
Claims must be submitted in a timely manner. You will not in any way report or count the value of the product provided under this Program as true out-of-pocket spending (TrOOP) under a Medicare Part D prescription drug benefit. You must not seek reimbursement or compensation, in whole or in part, from government health insurance (including Medicare, Medicaid, VA, DoD, or other federal or state assistance programs), a Flexible Spending Account (FSA), a Health Savings Account (HSA), or a Health Reimbursement Account (HRA). You are responsible for reporting receipt of co-pay assistance to any insurer, health plan, or other third party who pays for or reimburses any part of the medication or treatment cost using the Searchlight Support ® Out-of-Pocket Assistance Program, as may be required. To re-enroll, reverification of your insurance benefits is required to confirm that you continue to meet the eligibility requirements for participation in the Program. You must re-enroll annually to remain in the Program. You currently have private, commercial health insurance with prescription coverage for RADICAVA ® medication, and your insurance does not cover the entire cost of RADICAVA ®. You are being treated as an outpatient by a licensed healthcare provider in the US and have been prescribed RADICAVA ® (edaravone) by a licensed healthcare provider. Persons 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. This program is not valid in states where prohibited by law, taxed, or otherwise restricted. If you move or switch from commercial insurance to any government health insurance, you will no longer be eligible. You must not be enrolled in government health insurance, (ie, Medicare, Medicaid, VA, DoD, or other federal or state assistance programs). You must be 18 to 64 years of age and not enrolled in Medicare. Offer good only in the US and its territories. You must be a citizen or a permanent resident of the US or its territories, and reside in the US or its territories where co-pay assistance is not prohibited. Need help paying for va prescription medication free#
This offer may not be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription. Radicava ® is indicated for the treatment of amyotrophic lateral sclerosis (ALS).įor more information about RADICAVA ®, callĮligibility Requirements & Terms and Conditions Provider for medical advice about side effects. These are not all the possible side effects of Radicava ®. (contusion), problems walking (gait disturbance), and headache. The most common side effects of Radicava ® include bruising Symptoms of all the serious side effects. Your healthcare provider will monitor you during treatment to watch for signs and. Tell your healthcare provider right away or go to the nearest emergency room if you haveĪny of the following symptoms: hives swelling of the lips, tongue, or face fainting īreathing problems wheezing trouble swallowing dizziness itching or an asthma. Often in people who have asthma than in people who do not have asthma. Sodium bisulfite can alsoĬause less severe asthma episodes in certain people. Radicava ® contains sodium bisulfite, a sulfite that may cause a type ofĪllergic reaction that can be serious and life-threatening. Hypersensitivity reactions have happened in people receiving Radicava ® and can. Reactions and sulfite allergic reactions. 
Radicava ® may cause serious side effects, including hypersensitivity (allergic). What are the possible side effects of Radicava ®? Over-the-counter medicines, vitamins, and herbal supplements. Tell your healthcare provider about all the medicines you take, including prescription and You and your healthcare provider should decide if you 
are breastfeeding or plan to breastfeed. are pregnant or plan to become pregnant. Before you receive Radicava ® (edaravone), tell your healthcare providerĪbout all of your medical conditions, including if you:
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