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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 210
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 |
Genentech Access to Care Foundation (TNKase, Cathflo, Activase)
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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 be uninsured or underinsured and have a gross annual income at or below $100,000. The patient must also meet medical criteria which are not disclosed. The patient must also be a US resident or legal alien. This is a drug replacement program. They don't work with those who have Medicare part D.
The patient needs to provide documents showing proof of income.
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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 10, 2009 |
