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This program provides brand name medications at no or low cost.
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| Pharmaceutical Company |
Genentech, Inc. |
| Program Name |
Genentech Access to Care Foundation (TNKase, Cathflo, Activase) |
| Program Address |
1 DNA Way, Mail Stop 857A
South San Francisco, CA 94080 |
| Phone Number |
800-530-3083
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| Fax Number |
650-225-1366 |
| Medications on Program |
Activase Powder for Injection 50mg, 100mg (alteplase recombinant)
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| Application Forms |
Not Applicable |
On-line Application
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No on-line application available at this time |
| Web Site |
Click to go to program's web site |
| Eligibility Guidelines and Notes |
The patient must also be a US resident or legal alien. The Genentech® Access to Care Foundation (GATCF) was created to help qualified patients with unmet medical needs who are uninsured - or who have been denied coverage by their health plans obtain therapy. Therefore, if your patient has no insurance or their health plan has denied coverage for treatments, they can apply to GATCF to receive their medicine free of charge.
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| Application Process |
The doctor/doctors office starts the process by filling out the enrollment/statement of medical necessity form. The enrollment form/statement of medical necessity can be faxed,mailed or downloaded from the HCP section of their website. The completed application must be faxed back.
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| Application Requirements |
The doctor must fill out and sign the enrollment form. The patient needs to complete an authorization and release form which can be downloaded, mailed or faxed.
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| Program Details |
Up to a 30-day supply is sent to the doctor's office, hospital or pharmacy.
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| Last Updated |
July 06, 2010 |
