Dosage & Administration Drug label Prior authorization Financial assistance

Diacomit

(stiripentol)

DIACOMIT 250 MG Oral CapsuleDIACOMIT 250 MG Powder for Oral Suspension

View 2 more

NO BOXED WARNING

Dosage & administration

* The dosage of DIACOMIT is 50 mg/kg/day, administered by mouth in 2 or 3 divided doses, depending on age and weight.
* Capsules must be swallowed whole with a glass of water during a meal. Capsules should not be broken or opened.
* Powder for suspension should be mixed in a glass of water and should be taken immediately after mixing during a meal.
* Reduce dose or discontinue dose gradually.

drug label

Diacomit prescribing information

Report Adverse Event

prior authorization

Diacomit prior authorization resources

Most recent Diacomit prior authorization forms

View By Payer

Verified: Nov 26, 2023Cigna - Diacomit Prior Authorization Form

Complete Letter of Medical Necessity

Coverage Authorization Appeals

Learn More

Benefits investigation

Diacomit Patient Enrollment Form

VA Enrollment Form

Learn More

financial assistance

Diacomit financial assistance options

Co-pay savings program

commercial only

Enroll in Patient Savings Program

Learn More

Overview

Reduce patient OOP costs for drug (and occasionally for drug administration/infusion costs or drug-related test costs)

Patient benefit

A portion (or all) of patient OOP (deductible, copay), typically up to monthly and/or annual max

Patient eligibility

Patient must enroll or activate (may permit HCPs to enroll on patient’s behalf for HCP-administered drugs)
Generally, must have commercial insurance (rarely, may permit uninsured patients to use)
May never be used with government insurance

How to sign up

Cards may be downloadable digital cards or hard copies
Some pharmacos offer debit cards with pre-loaded copay benefit
Typically, available through multiple channels (e.g., rep to HCP to patient; pharmacy to patient; patient via website, Hub live agent, or copay vendor (live agent or IVR); patient and HCP via Hub enrollment form)
Some HCP-administered product programs permit HCPs to enroll on a patient’s behalf through via Hub form

Bridge program

commercial only

Enroll in Bridge Program

Learn More

Overview

Provide patient immediate access to therapy during an insurance delay (typically new starts; some may cover change in insurance)
Limited time/ fill (typically 7-30 days; some may offer additional fill for continued delay up to certain limit)

Patient benefit

100% free (outside of insurance)

Patient eligibility

HCP must enroll patient
May be limited to commercially insured patients (i.e., no government beneficiaries); some programs may allow government beneficiaries

How to sign up

Typically HCP assisted enrollment (via form)

Foundation programs

under insured

no insurance

goverment insurance

65+

Diacomit Patient Assistance Program Application

Learn More

Overview

Charitable 501(c)(3) organizations provide direct cost-sharing and other support (e.g., travel, counseling) through disease-state funds to indigent patients on first-come first-served basis
These organizations may receive financial contributions from drug manaufacturers for particular disease-state funds that cannot provide funds directly to patients - the foundation must be independent/unaligned

Patient benefit

Patients apply for grants that cover a portion (or all) of their out-of-pocket costs (deductibles and co-pays) until the grant is exhausted

Patient eligibility

Patients must apply and meet eligibility criteria including income level (typically a multiple of federal poverty line), specific diagnosis, insurance status, etc.

How to sign up

Patients submit proof of out-of-pocket drug costs to charities for reimbursement

patient education

Diacomit patient education

To share resource; ask patient to:

1.Pull out phone

2.Open camera

3.Scan QR code with camera

4.Tap link