Help for Uninsured Patients

The Genentech^® Access to Care Foundation (GATCF) was created to help patients who are uninsured—or who have been denied coverage for ACTEMRA^® (tocilizumab) by their health plans. GATCF might be able to help those patients receive ACTEMRA treatment if they meet specific financial and medical criteria.

Is my patient eligible?

For your patient to be eligible for help from GATCF, certain specific criteria must be met:

• Your patient must have no health insurance or the health plan has denied coverage for ACTEMRA
• Your patient’s annual household adjusted gross income must be $100,000 or less (special consideration may be given to patients with unique circumstances)
• Your patient must meet medical criteria determined by the GATCF Clinical Advisory Board

To determine if your patient qualifies, request a GATCF Eligibility Screening when you conduct the initial benefits investigation.

How do I get started?

To apply to GATCF, you must complete and submit the Statement of Medical Necessity (SMN) form and have your patient complete and submit a Patient Authorization and Notice of Release of Information (PAN) form.

The SMN can be submitted online via My Patient Solutions^™ or downloaded from Forms and Documents.

When completing the SMN, be sure to complete all sections of the form.

Once we receive your patient’s information, Genentech Rheumatology Access Solutions will contact the patient within 24 hours with further instructions. This may include verifying financial eligibility.

Additional GATCF Program details:

• Patients are eligible for free medicine for 1 year; patients must reapply annually
• Patient assistance support may be given before treatment or up to 1 year post-treatment
• GATCF assists with the cost of ACTEMRA only, not the administration costs

GATCF Eligibility Screening

If you have concerns about your patient's insurance coverage for ACTEMRA, you can ask for a GATCF Eligibility Screening at the time you submit the SMN. We can then assess whether a patient's medical condition and self-reported income meet GATCF criteria. If the patient's insurer denies coverage after treatment begins, your patient could be eligible for free ACTEMRA through GATCF.

To start the GATCF Eligibility Screening, check the appropriate box under Services Requested on the SMN form. Your patient must also certify their household adjusted gross income is $100,000 per year or less on the PAN form.

Within 24 hours of receiving completed SMN and PAN forms, Genentech Rheumatology Access Solutions will fax a letter to your office. A GATCF Eligibility Screening outcome notification will follow.

GATCF has the right to modify or end this program at any time and to verify the accuracy of the information you submit.

A GATCF Eligibility Screening approval letter does not guarantee acceptance into GATCF. It only states your patient appears to meet the GATCF medical and financial criteria based on a review of the documents. GATCF still needs to confirm the complete lack of insurance coverage for ACTEMRA. This includes exhausting the appeals process. GATCF also needs to verify the medical and financial qualifications based on the documentation supplied by your patient.