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Updated February 20, 2014
Invirase

Genentech Access to Care Foundation (HIV & Transplants)

This program provides brand name medications at no or low cost.

Provided by: Genentech, Inc.

P.O. Box 29064
Phoenix, AZ 85038

TEL: 888-754-7651


ALT PHONE:
FAX: 800-305-1830
Languages Spoken:

English

Program Website
 

Patient Assistance Applications

Genentech Patient Auth. and Notice of Release of Information (PAN); Cellcept & Valcyte

Genentech Patient Auth. and Notice of Release of Information (PAN); Cellcept & Valcyte (Spanish)

Genentech Statement of Medical Necessity - Cellcept

Genentech Statement of Medical Necessity - Valcyte

 

Medications

  • Invirase  Capsule 200mg (saquinavir)
  • Invirase  Tablet 500mg (saquinavir)
 

Eligibility Requirements

Insurance Status Must have no prescription coverage or been denied coverage
Those with Part D Eligible? Determined case by case
Income Gross annual household income at or below $100,000
Diagnosis/Medical Criteria Not disclosed
US Residency Required? Must be treated by US licensed healthcare provider
   

Application

Obtaining Doctor/Doctor's office starts process by filling out Statement of Medical Necessity Form
Receiving Faxed, mailed or downloaded from website
Returning Mail or fax
Doctor's Action Complete and sign statement of medical necessity
Applicant's Action Complete Patient Authorization and Notice of Information Form available on website, attach proof of income
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply Varies
Sent To Patient's home, doctor's office, hospital or pharmacy
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
Re-application New application yearly
   

Additional Information