Assistance Options for Your Eligible Patients

Several options are available to help eligible patients with the out-of-pocket costs of GAZYVA.

Find out if your patients could be eligible using the Patient Assistance Tool.

  • Is your patient insured?

  • Does your patient have commercial insurance?

    What does this mean?
  • Has your patient already been referred to the Genentech BioOncology Co-pay Card and is either ineligible or no longer receiving assistance?

  • Has your patient already been referred to an independent co-pay assistance foundation and is either ineligible or no longer receiving assistance?

  • Is the patient 18 years of age or older?

Your Patient Might Qualify for a Referral to the Genentech BioOncology Co-pay Card

If eligible commercially insured patients need assistance with their out-of-pocket costs, GAZYVA Access Solutions can refer them to the Genentech BioOncology Co-pay Card.*

 

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*In order to be eligible for the Genentech BioOncology Co-pay Card, the patient must have commercial insurance, must not have Medicare, Medicaid or other government insurance, and must meet other eligibility criteria. They also must agree to the rules set forth in the terms and conditions for the program. Please visit CopayAssistanceNow.com for the full list of terms and conditions.

Your Patient Might Qualify for a Referral to an Independent Co-pay Assistance Foundation

For eligible patients with commercial or public health insurance, GAZYVA Access Solutions offers referrals to independent co-pay assistance foundations.*

 

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*Genentech does not influence or control the operations or eligibility criteria of any independent co-pay assistance foundation and cannot guarantee co-pay assistance after a referral from GAZYVA Access Solutions. The foundations to which we refer patients are not exhaustive or indicative of Genentech’s endorsement or financial support. There may be other foundations to support the patient's disease state.

Your Patient Might Qualify for a Referral to the Genentech® Access to Care Foundation (GATCF)

GATCF helps eligible patients who meet specific criteria receive their Genentech medicine free of charge.*

 

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*To be eligible for free Genentech medicine from GATCF, insured patients must have exhausted all other forms of patient assistance (including the Genentech BioOncology Co-pay Card and support from independent co-pay assistance foundations) and meet financial criteria. Uninsured patients must meet different financial criteria.

Does Your Patient Have Commercial Insurance?

GAZYVA Access Solutions can refer eligible patients to the Genentech BioOncology® Co-pay Card Program for help with the out-of-pocket cost associated with GAZYVA.

Does Your Patient Have Insurance?

If eligible publicly or commercially insured patients have difficulty paying for their co-pay, co-insurance or other out-of-pocket (OOP) costs, GAZYVA Access Solutions can refer them to an independent co-pay assistance foundation supporting their disease state.

Is Your Patient Uninsured or Underinsured?

Genentech® Access to Care Foundation (GATCF) provides free medicine to eligible patients who are uninsured, rendered uninsured by payer denial or underinsured. To qualify, patients must meet financial criteria.

What is GAZYVA Access Solutions?

GAZYVA Access Solutions provides reliable, effective access and reimbursement support to assist your patients and practice after GAZYVA is prescribed.

Learn how we help.

How can I find what options are available for my patient?

Determine which patient assistance option is right for your patient with the Patient Assistance Tool at Genentech-Access.com/GAZYVA.

How can I enroll my patients?

To enroll in GAZYVA Access Solutions, complete and submit the following 2 forms:

  • The SMN—a form with patient, insurance and prescription information used when contacting a patient’s health insurance plan to determine his or her coverage.
  • The PAN—a form signed and dated by your patient giving written permission for GAZYVA Access Solutions to discuss his or her health information with you and the patient’s health insurance plan.

PAN=Patient Authorization and Notice of Request for Transmission of Health Information to Genentech Access Solutions and Genentech® Access to Care Foundation.
SMN=Statement of Medical Necessity.

Once enrolled in an option, how long will my patient keep receiving assistance?

Each option has its own time period where your eligible patients will receive assistance. You can call us at (866) 422-2377 for more information.

What if I have questions about your options?

To ask questions or to learn more about how we can help, contact us at (866) 422-2377.