Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 2.
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Genentech Patient Foundation

This program provides medication at no cost.

Provided by: Genentech USA, Inc.


TEL: 888-941-3331


ALT PHONE: 866-422-2377
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Genentech Patient Foundation Prescriber Form

Genentech Patient Foundation Patient Consent Form

Genentech Patient Foundation Patient Consent Form (Spanish)
 

Medications
  • alteplase (Cathflo) 
  • alteplase injection; iv (Activase) Injection; IV
 

Eligibility Requirements   
Insurance Status Uninsured or Underinsured with no prescription coverage for needed medication
Those with Part D Eligible? Contact program for details.
Income Based on FPL
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must be treated by US licensed healthcare provider
   

Application
Obtaining Call or download
Receiving Faxed or downloaded from website
Returning Fax, submit online, or send text image
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Patient and Doctor are notified
Decision Timeframe Varies
   

Medication
Amount/Supply Amount requested is sent
Sent To Patient's home, unless otherwise noted
Delivery Time Varies
Refill Process Varies per medication
Limit Contact the program for details
Re-application Contact program for details.
   

Additional Information
The Genentech Access to Care Foundation is now the Genentech Patient Foundation.

Eligibility determined on a case-by-case basis.

Call for most recent medications as the list is subject to change.

This program may provide a Bridge Program for eligible patients who experience a delay, temporary loss, or change in coverage. Contact program for details.


Updated May 02, 2023


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 2.
 

HealthWell Foundation Copay Program

This is a copay assistance program

Provided by: HealthWell Foundation


TEL: 800-675-8416


Languages Spoken:

English, Others By Translation Service

Program Website

 

Program Applications and Forms

HealthWell Foundation Copay Program Enrollment: Contact program
 

Medications
  • alteplase () 
 

Eligibility Requirements   
Insurance Status May have insurance
Those with Part D Eligible? Yes, but contact program for details
Income Varies
Diagnosis/Medical Criteria FDA Approved Diagnosis - See Program Website for Details
US Residency Required? Must reside in the US
   

Application
Obtaining Call or complete online
Receiving Varies
Returning Mail
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Patient notified
Decision Timeframe 3-5 business days
   

Medication
Amount/Supply Not applicable
Sent To Varies
Delivery Time Not specified
Refill Process Automatically sent out
Limit Contact the program for details
Re-application New application every 12 months
   

Additional Information
This program provides financial assistance to eligible individuals to cover coinsurance, copayments, healthcare premiums and deductibles for certain treatments. Also, for those who are eligible for health insurance, but cannot afford the insurance premium, the foundation may be able to help by paying some or all of the medical portion of insurance premiums. The patient is being treated for a specific disease for which funding is available and has insurance that covers the treatment for this disease.

Call for most recent medications as the list is subject to change.

Updated May 30, 2023