Radicava Patient Assistance Programs

Radicava: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Radicava. Review the information to see if you qualify. The applications are available in Adobe PDF format and should be mailed directly to the provider of the patient assistance program.

If you have any questions, please call the telephone number for the program (not PharmacyChecker.com) or go to the program website.

Looking for a different medication?

Searchlight Support Patient Assistance Program

(Program 1 of 1 — Scroll down to see them all)

Provided by: MT Pharma America, Inc. (MTPA)
PO Box 2930 Phoenix, AZ 85062
TEL: 844-772-4548
FAX: 888-782-6157
Languages Spoken:
English
Program Website
Medications
  • Radicava (edaravone)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? No
  • Income At or below 500% of FPL
  • Diagnosis/Medical Criteria Not specified
  • U.S. Residency Required? Must be US citizen or permanent resident residing in the US or US territories and treated by a US licensed doctor.
Application
  • Obtaining Call or download
  • Receiving Faxed or downloaded from website
  • Returning The completed application should be faxed back from the doctor's office.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Patient and Doctor are notified
  • Decision Timeframe Varies
Medication
  • Amount/Supply Varies
  • Sent To Varies
  • Delivery Time Varies
  • Refill Proces Not specified
  • Limit Up to two years
  • Re-application New application every 12 months
Additional Information
None
Updated April 30, 2018

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for Radicava prices here.

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