| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 1 of 3. Scroll down to see them all. |
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Genentech Patient FoundationThis program provides medication at no cost. |
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Provided by: Genentech USA, Inc. |
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TEL: 888-941-3331ALT PHONE: 866-422-2377 |
Languages Spoken:
English, Spanish, Others By Translation Service |
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Program Applications and Forms |
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Genentech Patient Foundation Prescriber Form |
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Genentech Patient Foundation Patient Consent Form |
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Genentech Patient Foundation Patient Consent Form (Spanish) |
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Medications |
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Eligibility Requirements |
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| 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 |
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| 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 |
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| 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 |
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| 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. |
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| 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 3. Scroll down to see them all. |
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Genentech Oncology Access SolutionsThis program provides brand name medications at no or low cost |
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Provided by: Genentech USA, Inc. |
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TEL: 888-249-4918ALT PHONE: 866-422-2377 |
Languages Spoken:
English, Spanish |
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Program Applications and Forms |
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Genentech Oncology Access Solutions Patient Consent Form |
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Genentech Oncology Access Solutions Patient Consent Form (Spanish) |
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Genentech Oncology Access Solutions Prescriber Service Form |
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Medications |
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Eligibility Requirements |
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| Insurance Status | Determined case by case | ||
| Those with Part D Eligible? | Determined case by case | ||
| Income | Based on FPL | ||
| Diagnosis/Medical Criteria | Varies | ||
| US Residency Required? | Must be treated by US licensed healthcare provider | ||
Application |
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| Obtaining | Call, download or apply online | ||
| Receiving | Faxed, emailed, mailed or downloaded | ||
| Returning | Fax, mail or submit online | ||
| 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 |
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| Amount/Supply | Varies | ||
| Sent To | Varies | ||
| Delivery Time | Contact Program for Details | ||
| Refill Process | Doctor/Doctor's office must contact the Program | ||
| Limit | Contact the program for details | ||
| Re-application | Contact program for details. | ||
Additional Information |
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| Call for most recent medications as the list is subject to change. Eligibility determined on a case-by-case basis. Contact program for details. |
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| Updated May 02, 2023 | |||
| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 3 of 3. | |||
Patient Access Network Foundation (PAN)This is a copay assistance program |
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Provided by: Patient Access Network Foundation |
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TEL: 866-316-7263FAX: 866-316-7261 |
Languages Spoken:
English, Spanish, Others By Translation Service |
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Program Applications and Forms |
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Patient Access Network Foundation (PAN) Application: Contact program |
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Medications |
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Eligibility Requirements |
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| Insurance Status | *See Additional Information section below | ||
| Those with Part D Eligible? | Determined case by case | ||
| Income | Between 400-500% of FPL | ||
| Diagnosis/Medical Criteria | FDA Approved Diagnosis - See Program Website for Details | ||
| US Residency Required? | Must reside and receive treatment in US | ||
Application |
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| Obtaining | Call or complete online | ||
| Receiving | Complete online or by phone | ||
| Returning | Not applicable | ||
| Doctor's Action | Varies | ||
| Applicant's Action | Call for information or inform doctor that he/she is in need | ||
| Decision Communicated | Patient and Doctor are notified | ||
| Decision Timeframe | Within 48 hours | ||
Medication |
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| Amount/Supply | Not applicable | ||
| Sent To | Patient is sent savings card to be used at pharmacy | ||
| Delivery Time | Once approved; shipped same day | ||
| Refill Process | Patient presents voucher/card to pharmacy for each refill | ||
| Limit | None | ||
| Re-application | New application every 12 months | ||
Additional Information |
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| *Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance. Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly. Note: All new enrollment is now done electronically or over the phone. Contact program for details. |
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| Updated June 05, 2023 | |||
