Dosage & Administration Drug label Prior authorization Financial assistance PubMed™ News

Tavalisse

(fostamatinib)

Tavalisse 100 MG Oral TabletTavalisse 150 MG Oral Tablet

NO BOXED WARNING

Dosage & administration

* Initiate TAVALISSE at 100 mg orally twice daily with or without food. After 4 weeks, increase to 150 mg twice daily, if needed, to achieve platelet counts of at least 50 × 109/L as necessary to reduce the risk of bleeding.
* Manage adverse reactions using dose reduction, interruption of treatment, or discontinuation.
* Discontinue TAVALISSE after 12 weeks of treatment if the platelet count does not increase to a level sufficient to avoid clinically important bleeding.

drug label

Tavalisse prescribing information

Contact Medical Science Liaison Report Adverse Event

prior authorization

Tavalisse prior authorization resources

Most recent Tavalisse prior authorization forms

View By Payer

Verified: Apr 07, 2024Kaiser Foundation Health Plan - Chronic High-Dose Opioid Therapy Prior Authorization Form Washington

Verified: Apr 01, 2024Highmark BCBS Northeastern NY - Medicare Prescription Drug Medication Request Form

Verified: Apr 01, 2024Highmark BCBS Northeastern NY - Short Acting Opioid Prior Authorization Form

Verified: Apr 01, 2024Highmark BCBS Western NY - Specialty Drug Prior Authorization Form

Verified: Apr 01, 2024Highmark BCBS Western NY - Non-Formulary Drug Coverage Prior Authorization Form

Most recent state uniform prior authorization forms

Verified: Mar 28, 2024Arizona - Uniform Prior Authorization Form

Verified: Mar 28, 2024Colorado - Uniform Prior Authorization Form

Verified: Mar 28, 2024Hawaii - Uniform Prior Authorization Form

Verified: Mar 28, 2024Illinois - Uniform Prior Authorization Form

Verified: Mar 28, 2024Indiana - Uniform Prior Authorization Form

Verified: Mar 28, 2024Louisiana - Uniform Prior Authorization Form

Verified: Mar 28, 2024Minnesota - Uniform Prior Authorization Form

Verified: Mar 28, 2024New Hampshire - Uniform Prior Authorization Form

Verified: Mar 28, 2024New Mexico - Uniform Prior Authorization Form

Verified: Mar 28, 2024Oregon - Uniform Prior Authorization Form

Verified: Mar 28, 2024Texas - Uniform Prior Authorization Form

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Benefits investigation

Tavalisse Rigel OneCare Enrollment Form

Tavalisse Rigel OneCare Enrollment Form - Spanish

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Reimbursement help (FRM)

Receive Assistance from an FRM Regarding Reimbursement Information

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financial assistance

Tavalisse financial assistance options

Co-pay savings program

commercial only

Tavalisse Rigel OneCare Enrollment Form

Tavalisse Rigel OneCare Enrollment Form - Spanish

Enroll in Patient Savings Program

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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

Tavalisse Rigel OneCare Enrollment Form

Tavalisse Rigel OneCare Enrollment Form - Spanish

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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+

Tavalisse Rigel OneCare Enrollment Form

Tavalisse Rigel OneCare Enrollment Form - Spanish

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

PubMed™ | Tavalisse

Tavalisse PubMed™ News

patient education

Tavalisse patient education

To share resource; ask patient to:

1.Pull out phone

2.Open camera

3.Scan QR code with camera

4.Tap link