| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
Genentech Access to Care Foundation (GATCF) ValcyteThis program provides brand name medications at no or low cost |
|||
Provided by: Genentech, Inc. |
|||
TEL: 888-754-7651FAX: 800-305-1830 |
Languages Spoken:
English, Spanish, Others By Translation Service |
||
Program Applications and Forms |
|||
Genentech Access to Care Foundation (Valcyte): Patient Auth. and Notice of Release (PAN) |
|||
Genentech Access to Care Foundation (Valcyte): Patient Auth. and Notice of Release (PAN) Spanish |
|||
Genentech Access to Care Foundation (Valcyte): Statement of Medical Necessity (SMN) |
|||
Medications |
|||
|
|||
Eligibility Requirements |
|||
| Insurance Status | Must be uninsured or underinsured | ||
| Those with Part D Eligible? | Determined case by case | ||
| Income | Not disclosed | ||
| Diagnosis/Medical Criteria | Medically appropriate condition/diagnosis | ||
| US Residency Required? | Must be treated in the US or Puerto Rico | ||
Application |
|||
| Obtaining | Call or download | ||
| Receiving | Faxed or downloaded from website | ||
| Returning | Fax or submit online | ||
| Doctor's Action | Complete section, sign, attach required documents | ||
| Applicant's Action | Complete section, sign, attach required documents | ||
| Decision Communicated | Doctor notified | ||
| Decision Timeframe | Varies | ||
Medication |
|||
| Amount/Supply | Amount requested is sent | ||
| Sent To | Varies | ||
| Delivery Time | Contact Program for Details | ||
| Refill Process | Contact program for details. | ||
| Limit | Contact the program for details | ||
| Re-application | New application every 12 months | ||
Additional Information |
|||
| Eligibility determined on a case-by-case basis. Contact program for details. |
|||
| Updated September 02, 2022 | |||
