Genentech Access Solutions
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 varies based 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 and financial 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 are eligible to receive free medicine for 1 year; they must reapply every year. For more information about the GATCF eligibility requirements, visit this website.
Genentech BioOncology Co-pay Card
Genentech also offers assistance options to help patients cover the out-of-pocket costs associated with their Genentech 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.
There are no income requirements to be eligible for this program. With this program, patients will pay a $25 copay per prescription or infusion, with an annual benefit limit of $25,000. Visit CopayAssistanceNow.com or call 855-692-6729 to learn more about copay assistance for specific medications.
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 My Patient Solutions tool.
The service requested must be indicated on the form, whether it is an initiation of benefits investigation or prior authorization, GATCF patient assistance, appeals support, and/or copay assistance.
Signed and dated Patient Authorization and Notice of Release of Information forms.
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. Access Solutions representatives can assist in educating how to complete 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.