Frequently Asked Questions

Genentech Access Solutions provides helpful access and reimbursement support to assist your patients and practice after a Genentech medicine is prescribed.

Genentech Access Solutions can conduct a benefits investigation (BI) to help you determine if a Genentech medicine is covered, if prior authorizations (PAs) are required, which specialty pharmacy (SP) the health insurance plan prefers and if financial assistance might be needed. You can request assistance by submitting the appropriate Prescriber Form and Patient Consent Form.

To learn more about coverage support, visit the Our Products page and select your patient’s prescribed medicine.

Your patient might not be able to get their prescribed medicine right away. First, your office or the specialty pharmacy will have to check to make sure the patient’s health insurance plan covers their medicine. Your office or the specialty pharmacy also might have to send some more information before the plan covers the medicine.

To learn more about coverage support, visit the Our Products page and select your patient’s prescribed medicine.

Some considerations for submitting claims:

• For new infused drugs, some payers may require the NDC in addition to, or instead of, a miscellaneous HCPCS code
• Keep complete, legible and easily accessible records
• Communicate with appropriate payer contacts to determine plan-specific requirements
• Monitor the first few claims submitted to each plan to learn about the plan’s requirements so you can apply the knowledge to future claims

To learn more about reimbursement support, visit the Our Products page and select your patient’s prescribed medicine.

HCPCS=Healthcare Common Procedure Coding System; NDC=National Drug Code.

There may be options to help your patient get the medicine you have prescribed. Genentech Access Solutions can refer your patient to financial assistance options.

To enroll your patient in coverage, reimbursement and financial assistance services:

1. You complete the appropriate Prescriber Form
2. Your patient completes the Patient Consent Form
3. You submit these forms to Genentech Access Solutions

You can submit the Prescriber Form online via Quick Enroll or My Patient Solutions for Health Care Practices^®. You can also download the form from Enrollment or obtain it from your Genentech representative and fax it to Genentech.

Both 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.

The Patient Consent Form gives us permission to discuss their health information with others, such as you and your office staff and their health insurance plan, so we can perform our services. We can’t work with your patient without a signed Patient Consent Form.

The Prescriber Service Form and Start Form are used to collect the patient’s health insurance and treatment information. It tells us you want to treat the patient with a particular medication. We can’t work with your patient without a completed Prescriber Service Form or Start Form.

The Prescriber Foundation Form is only for helping eligible patients receive free medication through the Genentech Patient Foundation. It collects treatment information as well as helps determine eligibility into the program. We can’t work with your patient without a completed Prescriber Foundation Form.

If your patient’s health insurance plan has issued a denial, your Genentech reimbursement representative or Genentech Access Solutions Specialist can provide resources as you prepare an appeal submission, as per your patient’s plan requirements. We can also follow up with the patient’s health plan about the status of their appeal.

A sample appeal letter and additional considerations are available in Resources.

Genentech Access Solutions cannot complete or submit an appeal for you.

We have resources to help you and your patient file an appeal. Your patient or your practice must file the appeal directly with the health insurance plan.

A sample appeal letter and additional considerations are available in Resources.

Genentech Access Solutions cannot complete or submit an appeal for you.

This depends on your patient’s health insurance plan. Your patient or your office staff can ask the plan directly about its process. Some appeals may be quick whereas other times it may take several months if an appeal has to be made several times. Genentech Access Solutions can follow up with a patient’s health insurance plan about the status of their appeal, if requested via My Patient Solutions^®.

Genentech Access Solutions cannot complete or submit an appeal for you.

If your patient’s health insurance changes while taking a Genentech medicine, direct your patient to call us at (877) GENENTECH/(877) 436-3683. We can help them understand their new coverage and available support.

If your patient’s health insurance changes while taking a Genentech medicine, direct your patient to call us at (877) GENENTECH/(877) 436-3683. We can help them understand their new coverage and available support.

The Genentech Patient Foundation gives free Genentech medicine to people who don’t have health insurance coverage or who have financial concerns and meet certain eligibility criteria.