Genentech Access Solutions offers a suite of programs and services to help facilitate access to Genentech BioOncology medicines for eligible patients. Support services include coverage and reimbursement assistance, financial assistance, and resource support.
For a list of oncology medicines from Genentech, see the Table.
The assistance provided by Genentech Access Solutions may vary depending on the patient’s insurance status.
Eligible patients who meet specified insurance, financial, and medical criteria may qualify to receive their Genentech medication at no cost through the Genentech Access to Care Foundation (GATCF).
Patients with private or commercial insurance may be eligible for copay assistance through the Genentech BioOncology Co-pay Card program.
Genentech Access Solutions can conduct a benefits investigation to facilitate an understanding of the patient’s health insurance coverage and potential costs associated with treatment; each investigation is medication-specific. The investigation may determine whether the treatment is covered, requires prior authorization, or is denied. If treatment is denied, an Access Solutions representative can help determine the next steps to take.
The program also offers resource support for questions related to billing and coding, as well as appeals for denied claims. If a patient’s coverage for a Genentech BioOncology medicine is denied, it is important to first understand the reason(s) for the denial, which should be explained in a letter from the insurer or the patient’s explanation of benefits.
An Access Solutions representative can then provide guidance during the development of an appeal; tips and checklists are available for appeals processes.
Additional services and resources may be available. For more information call 866-422-2377.
Genentech Access to Care Foundation
Eligible patients who meet specified insurance, financial, and medical criteria may qualify for this program.
- Uninsured patients, certain insured patients, as well as those who have been denied coverage for a prescribed Genentech drug(s) may qualify for the GATCF program if they meet the eligibility criteria
- Uninsured patients must have a household adjusted gross income of ≤$100,000 or $100,001 to $150,000 if their out-of-pocket cost for their Genentech medicines is for at least 5% of their annual household adjusted gross income
- Patients whose insurance covers Genentech medicines may qualify if their household adjusted gross income is ≤$150,000 and their out-of-pocket costs for their Genentech drugs account for at least 5% of their annual household adjusted gross income
- Patients must have exhausted all other assistance options, including medication-specific copay cards and support from copay assistance foundations
- Patients must also meet medical eligibility criteria established by an independent advisory board.
Genentech BioOncology Co-pay Card
Genentech also offers assistance options to help patients cover the out-of-pocket costs associated with their medications.
To be eligible for this program, patients must:
- Be covered by commercial or private insurance
- Be aged ≥18 years
- Reside and receive treatment in the United States or Puerto Rico
- Not be insured by state- or government-funded health plans, such as Medicare, Medicaid, Medigap, or TRICARE.
Genentech Access Solutions staff also can connect patients to independent copay assistance foundations. Drug-specific listings of copay assistance foundations are available at www.genentech-access.com.
Application & Enrollment
To enroll in the Genentech BioOncology Access Solutions program, patients and their physicians should complete the Statement of Medical Necessity form. The form may be completed via the online Patient Assistance Tool.
The service requested must be indicated on the form, whether it is an initiation of benefits investigation or prior authorization, GATCF patient assistance, GATCF eligibility screening, appeals support, and/or copay assistance.
Signed and dated Patient Authorization and Notice of Release of Information forms and copies of the front and back of the patient’s insurance card must be submitted; a completed GATCF Insurance Attestation form must also be submitted in case claim or prior authorization submission has been denied. Copy of tax returns or other proof of income may be required.
The patient’s medical information, including the primary and secondary diagnosis (a code must be provided), disease stage, line of therapy, previous therapy, and concurrent treatment prescribed with Genentech’s drugs must be completed. Patient Access Solutions representatives can assist in completing these forms.
Patients who wish to enroll in the GATCF should complete the Statement of Medical Necessity form with their physicians, as well as Patient Authorization and Notice of Release of Information forms.
In addition, uninsured patients must complete a GATCF insurance attestation form; all applicants should complete a confirmation of infusion or injection for office-administered drugs.
Receiving Genentech Medications
A list of authorized distributors for Genentech medications is available at www.genentech-access.com.