Dosage & Administration Biomarker testing Drug label Prior authorization Financial assistance

Tivdak

(tisotumab)

tivdak 40 MG Injection

Dosage & administration

* For intravenous infusion only. Do not administer TIVDAK as an intravenous push or bolus. Do not mix with, or administer as an infusion with, other medicinal products.
* The recommended dose of TIVDAK is 2 mg/kg (up to a maximum of 200 mg) given as an intravenous infusion over 30 minutes every 3 weeks until disease progression or unacceptable toxicity. ( 2.1)

biomarker testing

Tivdak clinical details

Genetic testing requirements were obtained from the NCCN guidelines for each cancer type.

drug label

Tivdak prescribing information

Contact Medical Science Liaison Report Adverse Event

prior authorization

Tivdak prior authorization resources

Most recent Tivdak prior authorization forms

View By Payer

Verified: Sep 28, 2023Cigna - Tivdak Prior Authorization Form

Verified: Sep 21, 2023Aetna - Tivdak Prior Authorization Form

PDFCoverage Authorization Request

PDFCoverage Authorization Appeals

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Benefits investigation

PDFHealthcare Provider Request Form For Tivdak (Form1/2)

PDFPatient Authorization Form For Tivdak (Form2/2)

PDFHealthcare Provider Request Form For Tivdak (Form1/2) - Spanish

PDFPatient Authorization Form For Tivdak (Form2/2) - Spanish

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financial assistance

Tivdak financial assistance options

Co-pay savings program

commercial only

PDFHealthcare Provider Request Form For Tivdak (Form1/2)

PDFPatient Authorization Form For Tivdak (Form2/2)

PDFHealthcare Provider Request Form For Tivdak (Form1/2) - Spanish

PDFPatient Authorization Form For Tivdak (Form2/2) - Spanish

OTHEREnroll in Patient Assistance 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

Foundation programs

under insured

no insurance

goverment insurance

65+

PDFHealthcare Provider Request Form For Tivdak (Form1/2)

PDFPatient Authorization Form For Tivdak (Form2/2)

PDFHealthcare Provider Request Form For Tivdak (Form1/2) - Spanish

PDFPatient Authorization Form For Tivdak (Form2/2) - Spanish

OTHERPatient Assistance Program

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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

Tivdak patient education

Getting started on Tivdak

To share resource; ask patient to:

1.Pull out phone

2.Open camera

3.Scan QR code with camera

4.Tap link