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 Access to Care Foundation (GATCF) Valcyte

This program provides brand name medications at no or low cost

Provided by: Genentech, Inc.

PO Box 29064,
Phoenix, AZ 85038

TEL: 888-754-7651


FAX: 800-305-1830
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

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 Statement of Medical Necessity: Valcyte

 

Medications

  • valganciclovir (Valcyte) 
 

Eligibility Requirements   

Insurance Status 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 June 08, 2020


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

Good Days Program

This is a copay assistance program

Provided by: Good Days from CDF

Attn: Enrollment
6900 Dallas Parkway
Suite #200
Plano, TX 75024

TEL: 877-968-7233


FAX: 214-570-3621
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Good Days Program Patient Enrollment Application (pages 3-5)

Good Days Program Enrollment Information Pages (pages 1 & 2)

Good Days Program Patient Enrollment Application (pages 3-5) (Spanish)

Good Days Program Enrollment Information Pages (pages 1 & 2) (Spanish)

 

Medications

  • valganciclovir () 
 

Eligibility Requirements   

Insurance Status Must have insurance
Those with Part D Eligible? Not specified
Income At or below 500% of FPL
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Yes and have social security number
   

Application

Obtaining Call, download or apply online
Receiving Faxed, mailed or downloaded from website
Returning Fax, mail or submit online
Doctor's Action Give prescription to patient
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Patient and/or Doctor are notified
Decision Timeframe Varies
   

Medication

Amount/Supply Not specified
Sent To Not specified
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
Re-application Must re-enroll at end of calendar year
   

Additional Information

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.
Updated June 26, 2020