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

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 Access to Care Foundation (Valcyte): Statement of Medical Necessity (SMN)

 

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 March 03, 2022