PiaSky Case Managers
A Case Manager may assist during your patient's treatment with coverage, reimbursement and financial assistance support.
Available Financial Assistance Options
The PiaSky Co-pay Program
If eligible commercially insured patients need assistance with their drug out-of-pocket costs, the PiaSky Co-pay Program may help.
To get started, call (800) 888-8051.
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, PiaSky Access Solutions offers referrals to independent co-pay assistance foundations that may be able to help.
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
PiaSky Sample Coding
This coding information may assist you as you complete the payer forms for PiaSky. 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 PiaSky Access Solutions Case Manager 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 PiaSky Access Solutions Case Manager 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 PiaSky Access Solutions on your behalf.
Coverage Resources
Benefits Investigations
PiaSky Access Solutions can conduct a benefits investigation (BI) to help you determine if PiaSky 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 PiaSky 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
PiaSky 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 PiaSky 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 PiaSky Access Solutions Case Manager 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.
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 PiaSky 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
Genentech has contracted with a network of specialty pharmacies (SPs) for customers choosing to prescribe PiaSky and works with them to help patients receive their medicines. SPs can dispense Genentech medicines to your office or directly to your patient and provide coverage and reimbursement support.
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 PiaSky Access Solutions to learn which SP the patient’s health insurance plan requires.
PiaSky is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS), which can be viewed online at www.PiaSkyREMS.com. Providers who prescribe PiaSky must be certified.
| Pharmacy | Telephone | Fax | Web Orders |
|---|---|---|---|
| Accredo | 866-712-5200 | 877-329-4605 | www.accredo.com |
| Alivia Specialty Pharmacy (Puerto Rico) | 787-979-2023 | N/A | www.aliviahealth.com/specialty-pharmacy |
| CVS Specialty | 800-237-2767 | 800-323-2445 | www.cvsspecialty.com |
| Onco360 (OncoMed Specialty) | 877-662-6633 | 877-662-6355 | www.onco360.com |
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.
Spoilage Replacement Program
To learn more about the Genentech Spoilage Replacement Program, click here.