ACTEMRA Case Managers
A Case Manager may assist during your patient's treatment with coverage, reimbursement and financial assistance support.
Available Financial Assistance Options
The ACTEMRA Co-pay Program
If eligible commercially insured patients need assistance with their drug out-of-pocket costs, the ACTEMRA Co-pay Program may help.
To get started, call (855) RA-COPAY (855-722-6729) or visit RACopay.com.
Eligibility criteria and benefit limits apply. Not valid for patients whose prescriptions are reimbursed under any federal or state government programs to pay for their Genentech medicine. Patients must be taking the Genentech medicine for an FDA-approved indication. Please visit the Co-pay Program website for the full list of Terms and Conditions.
Referrals to Independent Co-pay Assistance Foundations
For eligible patients with commercial or public health insurance, ACTEMRA Access Solutions offers referrals to independent co-pay assistance foundations that may be able to help.
Rheumatology: Patient Access Network Foundation (PANF) The Assistance Fund, Inc. Patient Advocate Foundation (PAF)
Neurology: The HealthWell Foundation
Pulmonology: At this time, no independent co-pay assistance foundations have been identified. Please call ACTEMRA Access Solutions at (866) 681-3261 for assistance.
Independent co-pay assistance foundations have their own rules for eligibility. Genentech has no involvement or influence in independent foundation decision-making or eligibility criteria and does not know if a foundation will be able to help your patient. We can only refer your patient to a foundation that supports their disease state. This information is provided as a resource for you. Genentech does not endorse or show preference for any particular foundation. The foundations in this list may not be the only ones that might be able to help your patient.
The Genentech Patient Foundation
If patients don’t have health insurance coverage or have financial concerns and meet eligibility criteria, they may be able to get Genentech medicine at no cost from the Genentech Patient Foundation.
Call (888) 941-3331 to speak with a live Foundation Specialist. We offer support in many different languages.
To be eligible for free Genentech medicine from the Genentech Patient Foundation, insured patients who have coverage for their medicine should try to pursue other forms of financial assistance, if available, and meet certain income requirements. Uninsured patients and insured patients without coverage for their medicine must meet a different set of income requirements. Genentech reserves the right to modify or discontinue the program at any time and to verify the accuracy of information submitted.
Reimbursement Support
ACTEMRA Sample Coding
This coding information may assist you as you complete the payer forms for ACTEMRA. These resources are provided for informational purposes only. Please visit CMS.gov or other payers’ websites to obtain additional guidance on their processes related to billing and coding for single-use vials and wastage.
Correct coding is the responsibility of the provider submitting the claim for the item or service. Please check with the payer to verify codes and special billing requirements. Genentech does not make any representation or guarantee concerning reimbursement or coverage for any item or service.
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Complete and submit a form electronically.
Appeals
If your patient’s health insurance plan has issued a denial, your Field Reimbursement Manager (FRM) or ACTEMRA Access Solutions Specialist can provide resources as you prepare an appeal submission, as per your patient’s plan requirements.
If a plan issues a denial:
The denial should be reviewed, along with the health insurance plan’s guidelines, to determine what to include in your patient’s appeal submission
Your FRM or ACTEMRA Access Solutions Specialist has local payer coverage expertise and can help you determine specific requirements for your patient
A sample appeal letter and additional considerations are available in Resources.
Appeals cannot be completed or submitted by ACTEMRA Access Solutions on your behalf.
Coverage Resources
Benefits Investigations
ACTEMRA Access Solutions can conduct a benefits investigation (BI) to help you determine if ACTEMRA is covered, if prior authorizations (PAs) are required, which specialty pharmacy (SP) the health insurance plan prefers and if financial assistance might be needed.
Potential outcomes of a BI:
- Treatment is covered
- PA is required
- Treatment is denied
Both the Prescriber Service Form and the Patient Consent Form must be received before ACTEMRA Access Solutions can begin helping your patient.
Forms can be downloaded from Enrollment or submitted online via My Patient Solutions®.
A sample appeal letter and additional considerations are available in Resources.
The completion and submission of coverage- or reimbursement-related documentation are the responsibility of the patient and health care provider. Genentech makes no representation or guarantee concerning coverage or reimbursement for any service or item.
Prior Authorization
ACTEMRA Access Solutions can help you identify if a prior authorization (PA) is necessary and offer resources as you request it for your patient. Both the Prescriber Service Form and the Patient Consent Form must be received before ACTEMRA Access Solutions can begin helping your patient.
Forms can be downloaded from Enrollment or submitted online via My Patient Solutions®.
If your patient’s request for a PA is not granted, your Field Reimbursement Manager (FRM) or ACTEMRA Access Solutions Specialist can work with you to determine your next steps. You can find more tips like this in Resources.
The completion and submission of coverage- or reimbursement-related documentation are the responsibility of the patient and health care provider. Genentech makes no representation or guarantee concerning coverage or reimbursement for any service or item.
Rheumatology Subsequent Verification Program (RSVP) for ACTEMRA for Intravenous (IV) Infusion
When a medical treatment is authorized for a limited period of time, it will generally require recertification for coverage of continued treatment. ACTEMRA Access Solutions can help you obtain recertification for your patients.
ACTEMRA patients enrolled in ACTEMRA Access Solutions are automatically enrolled in RSVP. Use this form to opt out of this program.
You also have the opportunity to request an annual reverification of benefits through My Patient Solutions®.
Enrollment
To enroll in Genentech patient support services, both you and your patient will need to complete the required forms.
For Patients: (choose one)
- Patient Consent Form - English
- Patient Consent Form - Spanish
For Providers: (choose one)
- Prescriber Service Form (to enroll patients in ACTEMRA Access Solutions)
- Prescriber Foundation Form (to enroll eligible patients into the Genentech Patient Foundation only)
Enroll patients online and manage service requests using My Patient Solutions®
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.
Distribution
Specialty Pharmacies
ACTEMRA Access Solutions works with specialty pharmacies (SPs) to help patients receive their medicines.
An SP may provide the following services:
- Reimbursement resources
- Clinical services to support patients throughout their treatment
- The ability to manage the specialty handling and shipping needs linked with many specialty therapies
You can work with your preferred SP or contact ACTEMRA Access Solutions to learn which SP the patient’s health insurance plan requires.
Genentech does not influence or advocate the use of any one specialty distributor or SP. We make no representation or guarantee of service or coverage of any item.
Buy and Bill
With buy and bill, the practice purchases the medication in advance, then bills the patient’s health insurance plan for reimbursement. The practice is responsible for storing and handling the drug, as well as collecting the patient’s co-pay for both the drug and its administration. With buy and bill, practices can maintain a stock of the drug, giving them the flexibility to treat patients when clinically appropriate.
For ACTEMRA for Intravenous (IV) Infusion
Genentech has contracted with a network of authorized specialty distributors to service practices choosing to purchase ACTEMRA IV through the buy and bill model. Customers can purchase ACTEMRA IV through authorized specialty distributors and wholesalers that have made a commitment to product integrity. These partners have agreed to distribute only products purchased directly from Genentech and not to distribute ACTEMRA IV through secondary channels.
| Distributor | Telephone | Fax | Web Orders |
|---|---|---|---|
| ASD Healthcare (Cencora) | 800-746-6273 | 800-547-9413 | www.asdhealthcare.com |
| Besse Medical (Cencora) | 800-543-2111 | 800-543-8695 | www.besse.com/home |
| Cardinal Health Distribution | 800-926-3161 | N/A | www.cardinalhealth.com/en/about-us/contact-us.html |
| Cardinal Health Specialty Distribution | 866-677-4844 | N/A | www.cardinalhealth.com/en/solutions/specialty-distribution.html |
| CuraScript SD (Priority Health) | 877-599-7748 | 800-862-6208 | curascriptsd.com/Contact-Us |
| Dakota Drug | 866-210-5887 | 763-421-0661 | www.dakdrug.com/ContactUs.aspx |
| DMS Pharmaceutical | 877-788-1100 | 847-518-1105 | www.dmspharma.com/contact-us |
| Harvard Drug (Cardinal Health Distribution) | 800-875-0123 | N/A | www.theharvarddruggroup.com |
| McKesson Plasma and Biologics (MPB) | 877-625-2566 | N/A | www.mckesson.com/Pharmaceutical-Distribution/Plasma-Biologics/ |
| Metro Medical (Cardinal Health) | 800-768-2002 | 615-256-4194 | www.metromedicalorder.com |
| Morris & Dickson | 800-388-3833 | 318-524-3096 | www.morrisdickson.com/products/specialty/ |
| Oncology Supply (Cencora) | 800-633-7555 | 800-248-8205 | www.oncologysupply.com/ |
| Distributor | Telephone | Fax | Web Orders |
|---|---|---|---|
| ASD Healthcare (Cencora) | 800-746-6273 | 800-547-9413 | www.asdhealthcare.com |
| Besse Medical (Cencora) | 800-543-2111 | 800-543-8695 | www.besse.com/home |
| Cardinal Health Distribution | 800-926-3161 | N/A | www.cardinalhealth.com/en/about-us/contact-us.html |
| Cardinal Health Specialty Distribution | 866-677-4844 | N/A | www.cardinalhealth.com/en/solutions/specialty-distribution.html |
| Harvard Drug (Cardinal Health Distribution) | 800-875-0123 | N/A | www.theharvarddruggroup.com |
| McKesson US Pharmaceutical ("USP") | 855-625-4677 | N/A | mckesson.com/Contact-Us/Support-Contacts/ |
| Metro Medical (Cardinal Health) | 800-768-2002 | 615-256-4194 | www.metromedicalorder.com |
| Morris & Dickson | 800-388-3833 | 318-524-3096 | www.morrisdickson.com/products/specialty/ |
| Oncology Supply (Cencora) | 800-633-7555 | 800-248-8205 | www.oncologysupply.com/ |
| Distributor | Telephone | Fax | Web Orders |
|---|---|---|---|
| ASD Healthcare (Cencora) | 800-746-6273 | 800-547-9413 | www.asdhealthcare.com |
| Besse Medical (Cencora) | 800-543-2111 | 800-543-8695 | www.besse.com/home |
| Cardinal Health Specialty Distribution | 866-677-4844 | N/A | www.cardinalhealth.com/en/solutions/specialty-distribution.html |
| CuraScript SD (Priority Health) | 877-599-7748 | 800-862-6208 | curascriptsd.com/Contact-Us |
| McKesson Plasma and Biologics (MPB) | 877-625-2566 | N/A | www.mckesson.com/Pharmaceutical-Distribution/Plasma-Biologics/ |
| McKesson Specialty Health (McKesson Specialty Care Distribution Corporation) | 800-482-6700 | N/A | www.mckesson.com/specialty/ |
| Metro Medical (Cardinal Health) | 800-768-2002 | 615-256-4194 | www.metromedicalorder.com |
| Oncology Supply (Cencora) | 800-633-7555 | 800-248-8205 | www.oncologysupply.com/ |
| Distributor | Telephone | Fax | Web Orders |
|---|---|---|---|
| ASD Healthcare (Cencora) | 800-746-6273 | 800-547-9413 | www.asdhealthcare.com |
| Besse Medical (Cencora) | 800-543-2111 | 800-543-8695 | www.besse.com/home |
| Cardinal Health Specialty Distribution | 866-677-4844 | N/A | www.cardinalhealth.com/en/solutions/specialty-distribution.html |
| CuraScript SD (Priority Health) | 877-599-7748 | 800-862-6208 | curascriptsd.com/Contact-Us |
| McKesson Plasma and Biologics (MPB) | 877-625-2566 | N/A | www.mckesson.com/Pharmaceutical-Distribution/Plasma-Biologics/ |
| McKesson Specialty Health (McKesson Specialty Care Distribution Corporation) | 800-482-6700 | N/A | www.mckesson.com/specialty/ |
| Metro Medical (Cardinal Health) | 800-768-2002 | 615-256-4194 | www.metromedicalorder.com |
| Morris & Dickson | 800-388-3833 | 318-524-3096 | www.morrisdickson.com/products/specialty/ |
| Oncology Supply (Cencora) | 800-633-7555 | 800-248-8205 | www.oncologysupply.com/ |
| Distributor | Telephone | Fax | Web Orders |
|---|---|---|---|
| Cardinal Health Puerto Rico | 787-625-4200 | N/A | cardinalhealth.pr/ |
| Cesar Castillo (Puerto Rico) | 787-999-1616 | 787-999-1618 | cesarcastillo.com/ |
Many specialty pharmacies are in-network with access to this product. If you are a pharmacy and would like to request product access, please visit our Indirect Access Program website.
For ACTEMRA for Subcutaneous (SC) Injection
Customers can purchase ACTEMRA SC through authorized specialty distributors and wholesalers that have made a commitment to product integrity. These partners have agreed to distribute only products purchased directly from Genentech and not to distribute ACTEMRA SC through secondary channels.
ACTEMRA Access Solutions works with SPs to help patients receive their medicines. SPs can dispense Genentech medicines directly to your patients. The SPs can also provide coverage and reimbursement support.
| Distributor | Telephone | Fax | Web Orders |
|---|---|---|---|
| ASD Healthcare (Cencora) | 800-746-6273 | 800-547-9413 | www.asdhealthcare.com |
| Besse Medical (Cencora) | 800-543-2111 | 800-543-8695 | www.besse.com/home |
| Cardinal Health Distribution | 800-926-3161 | N/A | www.cardinalhealth.com/en/about-us/contact-us.html |
| Cardinal Health Specialty Distribution | 866-677-4844 | N/A | www.cardinalhealth.com/en/solutions/specialty-distribution.html |
| CuraScript SD (Priority Health) | 877-599-7748 | 800-862-6208 | curascriptsd.com/Contact-Us |
| Dakota Drug | 866-210-5887 | 763-421-0661 | www.dakdrug.com/ContactUs.aspx |
| DMS Pharmaceutical | 877-788-1100 | 847-518-1105 | www.dmspharma.com/contact-us |
| Harvard Drug (Cardinal Health Distribution) | 800-875-0123 | N/A | www.theharvarddruggroup.com |
| McKesson Plasma and Biologics (MPB) | 877-625-2566 | N/A | www.mckesson.com/Pharmaceutical-Distribution/Plasma-Biologics/ |
| Metro Medical (Cardinal Health) | 800-768-2002 | 615-256-4194 | www.metromedicalorder.com |
| Morris & Dickson | 800-388-3833 | 318-524-3096 | www.morrisdickson.com/products/specialty/ |
| Oncology Supply (Cencora) | 800-633-7555 | 800-248-8205 | www.oncologysupply.com/ |
| Distributor | Telephone | Fax | Web Orders |
|---|---|---|---|
| ASD Healthcare (Cencora) | 800-746-6273 | 800-547-9413 | www.asdhealthcare.com |
| Besse Medical (Cencora) | 800-543-2111 | 800-543-8695 | www.besse.com/home |
| Cardinal Health Distribution | 800-926-3161 | N/A | www.cardinalhealth.com/en/about-us/contact-us.html |
| Cardinal Health Specialty Distribution | 866-677-4844 | N/A | www.cardinalhealth.com/en/solutions/specialty-distribution.html |
| Harvard Drug (Cardinal Health Distribution) | 800-875-0123 | N/A | www.theharvarddruggroup.com |
| McKesson US Pharmaceutical ("USP") | 855-625-4677 | N/A | mckesson.com/Contact-Us/Support-Contacts/ |
| Metro Medical (Cardinal Health) | 800-768-2002 | 615-256-4194 | www.metromedicalorder.com |
| Morris & Dickson | 800-388-3833 | 318-524-3096 | www.morrisdickson.com/products/specialty/ |
| Oncology Supply (Cencora) | 800-633-7555 | 800-248-8205 | www.oncologysupply.com/ |
| Distributor | Telephone | Fax | Web Orders |
|---|---|---|---|
| ASD Healthcare (Cencora) | 800-746-6273 | 800-547-9413 | www.asdhealthcare.com |
| Besse Medical (Cencora) | 800-543-2111 | 800-543-8695 | www.besse.com/home |
| Cardinal Health Specialty Distribution | 866-677-4844 | N/A | www.cardinalhealth.com/en/solutions/specialty-distribution.html |
| CuraScript SD (Priority Health) | 877-599-7748 | 800-862-6208 | curascriptsd.com/Contact-Us |
| McKesson Plasma and Biologics (MPB) | 877-625-2566 | N/A | www.mckesson.com/Pharmaceutical-Distribution/Plasma-Biologics/ |
| McKesson Specialty Health (McKesson Specialty Care Distribution Corporation) | 800-482-6700 | N/A | www.mckesson.com/specialty/ |
| Metro Medical (Cardinal Health) | 800-768-2002 | 615-256-4194 | www.metromedicalorder.com |
| Oncology Supply (Cencora) | 800-633-7555 | 800-248-8205 | www.oncologysupply.com/ |
| Distributor | Telephone | Fax | Web Orders |
|---|---|---|---|
| ASD Healthcare (Cencora) | 800-746-6273 | 800-547-9413 | www.asdhealthcare.com |
| Besse Medical (Cencora) | 800-543-2111 | 800-543-8695 | www.besse.com/home |
| Cardinal Health Specialty Distribution | 866-677-4844 | N/A | www.cardinalhealth.com/en/solutions/specialty-distribution.html |
| CuraScript SD (Priority Health) | 877-599-7748 | 800-862-6208 | curascriptsd.com/Contact-Us |
| McKesson Plasma and Biologics (MPB) | 877-625-2566 | N/A | www.mckesson.com/Pharmaceutical-Distribution/Plasma-Biologics/ |
| McKesson Specialty Health (McKesson Specialty Care Distribution Corporation) | 800-482-6700 | N/A | www.mckesson.com/specialty/ |
| Metro Medical (Cardinal Health) | 800-768-2002 | 615-256-4194 | www.metromedicalorder.com |
| Morris & Dickson | 800-388-3833 | 318-524-3096 | www.morrisdickson.com/products/specialty/ |
| Oncology Supply (Cencora) | 800-633-7555 | 800-248-8205 | www.oncologysupply.com/ |
| Distributor | Telephone | Fax | Web Orders |
|---|---|---|---|
| Cardinal Health Puerto Rico | 787-625-4200 | N/A | cardinalhealth.pr/ |
| Cesar Castillo (Puerto Rico) | 787-999-1616 | 787-999-1618 | cesarcastillo.com/ |
ACTEMRA SC is broadly available to health care providers and pharmacies.
We work with these authorized distributors and specialty pharmacies to provide ACTEMRA to patients and the prescribers.
Genentech does not influence or advocate the use of any one specialty distributor or specialty pharmacy. We make no representation or guarantee of service or coverage of any item.
Spoilage Replacement Program
To learn more about the Genentech Spoilage Replacement Program, click here.