Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  

Genentech Access to Care Foundation (Alecensa)

This program provides brand name medications at no or low cost

Provided by: Genentech, Inc.

Genentech Access Solutions
1 DNA Way, Mail Stop #858a
South San Francisco, CA 94080-4990

TEL: 866-422-2377

ALT PHONE: 888-249-4918
FAX: 877-313-2659
Languages Spoken:

English Spanish Others By Translation Service

Program Website


Patient Assistance Applications

Genentech Patient Auth. and Notice of Release of Information (PAN): Alecensa

Genentech Patient Auth. and Notice of Release of Information (PAN): Alecensa (Spanish)

Genentech Statement of Medical Necessity: Alecensa


Brand Name Medications Covered

  • Alecensa

Generic Name

  • alectinib

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 FDA-approved diagnosis
US Residency Required? Must be treated by US licensed healthcare provider


Obtaining Doctor/Doctor's office starts process by filling out enrollment/statement of medical necessity forms
Receiving Faxed, mailed or downloaded from website
Returning Fax or mail
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


Amount/Supply Varies
Sent To Varies
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
Re-application New application yearly

Additional Information

Updated February 14, 2018