Genentech Access Solutions

Patient Support Services Guide 2019


Genentech Access Solutions
866-422-2377

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.

Financial Assistance

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 Patient Foundation.

Patients with private or commercial insurance may be eligible for copay assistance through the Genentech BioOncology Co-pay Card program.

Benefits Assistance

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.

Reimbursement Assistance

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.

Eligibility

Genentech Patient 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 Genentech Patient Foundation program if they meet the eligibility criteria
  • Uninsured patients must have a household adjusted gross income of ≤$150,000.
  • Patients whose insurance covers Genentech medicines may qualify if their household adjusted gross income is ≤$150,000.
  • Patients must have exhausted all other assistance options, including medication-specific copay cards and support from copay assistance foundations.

Click here for more information about the Genentech Patient Foundation eligibility requirements.

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.

This program has no income requirements. With this program, patients will pay a $5 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 Genentech medications.

Copay Foundations

Genentech Access Solutions staff also can connect patients to independent copay assistance foundations. Drug-specific listings of copay assistance foundations are available at 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, Genentech Patient Foundation 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 Genentech Patient Foundation 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 Genentech Patient Foundation insurance attestation form.

Table Genentech Oncology Drugs

Drugs
Indications
Patient support programs

Drug
Actemra (tocilizumab) injection
Indication
Cytokine release syndrome induced by CAR T-cell therapy

Drug
Alecensa (alectinib)
Indication
Metastatic NSCLC with ALK mutation

Drug
Avastin (bevacizumab)
Indication

Drug
Cotellic (cobimetinib)
Indication
Unresectable or metastatic melanoma

Drug
Erivedge (vismodegib)
Indication
Metastatic basal-cell carcinoma

Drug
Gazyva (obinutuzumab)
Indication
Untreated chronic lymphocytic leukemia, in combination with chlorambucil; follicular lymphoma refractory to rituximab-containing regimen, in combination with bendamustine, then obinutuzumab monotherapy

Drug
Herceptin (trastuzumab)
Indication
HER2-positive breast cancer

Drug
Kadcyla (ado-trastuzumab emtansine)
Indication
Metastatic HER2-positive breast cancer

Drug
Perjeta (pertuzumab)
Indication
HER2-positive breast cancer

Drug
Rituxan (rituximab)
Indication
Low-grade or follicular CD20-positive non-Hodgkin lymphoma; CD20-positive chronic lymphocytic leukemia

Drug
Rituxan Hycela (rituximab and hyaluronidase human) injection
Indication
Relapsed or refractory follicular lymphoma; untreated follicular lymphoma, in combination with first-line chemotherapy, and as maintenance monotherapy in patients with complete or partial response to rituximab plus chemotherapy; as monotherapy for nonprogressing follicular lymphoma after first-line chemotherapy; untreated DLBCL, in combination with chemotherapy; chronic lymphocytic leukemia, in combination with fludarabine and cyclophosphamide

Drug
Tarceva (erlotinib)
Indication
Advanced pancreatic cancer; advanced NSCLC

Drug
Tecentriq (atezolizumab)
Indication

Drug
Venclexta (venetoclax)
Indication
Chronic lymphocytic leukemia with 17p deletion; chronic lymphocytic leukemia or small lymphocytic lymphoma, with or without 17p deletion, after 1 previous therapy; in combination with azacytidine, decitabine, or low-dose cytarabine for newly diagnosed acute myeloid leukemia in patients aged ≥75 years or whose comorbidities preclude intensive induction chemotherapy

Drug
Xeloda (capecitabine)
Indication
Colon cancer; metastatic CRC; metastatic breast cancer
Patient support program

Drug
Zelboraf (vemurafenib)
Indication
Unresectable metastatic melanoma with BRAF mutation

CRC indicates colorectal cancer; DLBCL, diffuse large B-cell lymphoma; NSCLC, non–small-cell lung cancer.