Rigel OneCare

Patient Support Services Guide 2019


Rigel OneCare
833-744-3562

Rigel Pharmaceuticals offers the Rigel OneCare patient support program, which provides several financial assistance options and support services for patients who have been prescribed Tavalisse (fostamatinib disodium hexahydrate) tablets.

Tavalisse, a kinase inhibitor, is indicated for the treatment of thrombocytopenia in adults with chronic immune thrombocytopenia who have had an insufficient response to previous treatments (Table).

Rigel OneCare

Rigel OneCare offers a range of support services for patients who are prescribed Tavalisse, including:

  • Benefit verification, preauthorization
  • Determination of eligibility and help with program enrollment for copay and financial assistance
  • Providing clinical support and educational materials during treatment.

Rigel OneCare offers 2 financial assistance programs related to Tavalisse.

Tavalisse Copay Assistance Program

Through the Tavalisse Copay Assistance Program, commercially insured patients may be eligible for a copay of $15 per month for Tavalisse, with an annual limit of $15,000.

Free Drug Supply Program

For eligible patients whose coverage has not begun, the Free Drug Supply Program provides a free supply of Tavalisse while appropriate insurance authorizations are being processed.

Eligibility

Tavalisse Copay Assistance Program

To qualify for the Tavalisse Copay Assistance Program, patients must:

  • Have commercial insurance
  • A valid prescription for Tavalisse
  • Not participate in a federal- or state-funded program, including Medicare, Medicaid, or TriCare
  • Have their prescriptions filled in the United States or Puerto Rico
  • Be aged ≥18 years.

Free Drug Supply Program

To participate in the Tavalisse Free Drug Supply Program, patients must:

  • Have met eligibility criteria for the Tavalisse Copay Assistance Program
  • Be securing insurance authorization
  • Not count free medication toward Medicare Part D out-of-pocket costs, or claim reimbursement from any third-party payer.

For more information about patient assistance options, call Rigel OneCare at 833-744-3562.

Application & Enrollment

Tavalisse Copay Assistance Program

Patients or pharmacists may enroll in the Tavalisse Copay Assistance Program using the online portal. After completion of the enrollment process and patient eligibility confirmation, the copay card may be printed out and presented to the specialty pharmacy. Alternatively, the Tavalisse enrollment form, including a separate prescription if the form does not comply with state prescription laws, may be completed and faxed to 833-397-4435.

Free Drug Supply Program

The completed Tavalisse enrollment form, including a separate prescription if the form does not comply with state prescription laws, should be faxed to 833-397-4435.

Table Rigel Pharmaceuticals Oncology Drug

Drug
Indications
Patient support programs

Drug
Tavalisse (fostamatinib disodium hexahydrate) tablets
Indication
Treatment of thrombocytopenia in adults with chronic immune thrombocytopenia and insufficient response to previous therapies