The first step in getting assistance from Genentech patient support services is enrollment, with forms available to download and print or submit online.
Patients always complete the Patient Consent Form, while prescribers choose a form based on the specific patient needs:
- If the patient needs help understanding coverage, financial assistance to help pay for their co-pays or educational support, use the Prescriber Service Form
- If the patient meets income requirements and has no insurance, insurance but no coverage or insurance but is struggling with high out-of-pocket costs and meets eligibility criteria, use the Prescriber Foundation Form
Both forms—the Patient Consent Form and one of the Prescriber Forms—must be received before Genentech can begin helping your patient. Only the information requested on these forms is required. Providing unrequested documents or information will delay processing.