Download the Benefit Investigation and Enrollment Form (BIF) to prescribe RADICAVA ORS® or RADICAVA® IV and enroll patients in the JourneyMate Support Program™.
Guides & Forms
Get useful tools and resources for your office and patients.
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Downloadable Materials
Benefit Investigation and Enrollment Form for RADICAVA ORS® and RADICAVA® IV
Order Form for Buy & Bill for RADICAVA® IV
Learn how to place subsequent orders for RADICAVA®. For IV only.
Example Treatment Initiation Checklist for RADICAVA ORS®
Use this checklist to facilitate a common understanding of the steps involved in coordinating treatment initiation for RADICAVA ORS®.
Example Treatment Initiation Checklist for RADICAVA® IV
Use this checklist to facilitate a common understanding of the steps involved in coordinating treatment initiation for RADICAVA® IV.
Sample Letter of Medical Necessity
This letter provides rationale for treatment with your prescribed medication. It can help when filing appeals.
Sample Appeal Letter
This letter may be considered if your patient’s request for an exception is denied.
Sample Exceptions Letter
This letter may be considered if your patient’s coverage is denied because the prescribed medication is not on your patient’s health plan formulary, or for another reason.
Financial Support Options Overview
Use with your patients to help them navigate options that may be available to them to help cover applicable out-of-pocket costs associated with their prescribed RADICAVA ORS® or RADICAVA® IV medication.
Out-of-Pocket Assistance Program Brochure for RADICAVA ORS® and RADICAVA® IV for HCPs
Learn more about the Out-of-Pocket Assistance Program for RADICAVA ORS® and RADICAVA® IV for your patients.
Preparing the Infusion Bag Flashcard
Download a reminder of the steps to properly prepare the infusion bag.
Modes of Infusion Brochure
Learn more about infusing RADICAVA® via a central or peripheral IV device.
Prescribing Information
Review the Prescribing Information for RADICAVA®.
Out-of-Pocket Assistance Program Brochure for RADICAVA ORS® and RADICAVA® IV for Patients
Provide information about the Out-of-Pocket Assistance Program for RADICAVA ORS® and RADICAVA® IV for eligible patients with commercial insurance.
Understanding Government Health Plan Options Brochure
Provide patients with information about government health plan options that may be available.
Patient Assistance Program Brochure
Learn about the Patient Assistance Program for uninsured patients who are in financial need.
2022 Open Enrollment Information for Patients Brochure
Help patients understand their coverage options. This brochure does not include a complete list of health plan options.
Out-of-Pocket Assistance Program Enrollment Form
Patients can complete and submit this form to the JourneyMate Support Program™ Insurance & Access Specialist to enroll in the Out-of-Pocket Assistance Program.
Patient Authorization Form
Patient authorization is required to complete a BIF. Patients can provide this authorization online or via mail, fax, or electronic fax.
Patient Information
Provide patients with more information about receiving RADICAVA ORS® and RADICAVA® IV.
