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Genentech Access to Care Foundation (Actemra)

This program provides brand name medications at no or low cost

Provided by: Genentech, Inc.

Genentech Access Solutions
1 DNA Way, Mail Stop #858a
South San Francisco, CA 94080-4990

TEL: 866-422-2377

ALT PHONE: 866-681-3261
FAX: 866-681-3288
Languages Spoken:

English, Spanish

Program Website


Patient Assistance Applications

Genentech Patient Auth. and Notice of Release of Information (PAN) Actemra

Genentech Patient Auth. and Notice of Release of Information (PAN): Actemra (Spanish)

Genentech Statement of Medical Necessity: Actemra


Brand Name Medications Covered

  • Actemra injection

Generic Name

  • tocilizumab injection

Eligibility Requirements   

Insurance Status Uninsured or Underinsured
Those with Part D Eligible? Determined case by case
Income Household income at or less than $150,000
Diagnosis/Medical Criteria Not applicable
US Residency Required? Must be treated by US licensed healthcare provider


Obtaining Doctor/Doctor's office starts process by filling out enrollment/statement of medical necessity forms
Receiving Faxed, mailed or downloaded from website
Returning Email, fax, mail or submit online
Doctor's Action Complete and sign statement of medical necessity
Applicant's Action Complete Patient Authorization and Notice of Information Form available on website, attach proof of income
Decision Communicated Doctor notified
Decision Timeframe Varies


Amount/Supply Varies
Sent To Varies
Delivery Time Contact Program for Details
Refill Process Doctor/Doctor's office must contact company
Limit One year
Re-application Contact program for details.

Additional Information

This program also provides copay assistance.

Updated October 15, 2018