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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.

 


 

 

Genentech® Access to Care Foundation (GATCF) Extension for Medicare Part D

Administered through GATCF, the GATCF Extension for Medicare Part D Patients is a program providing ACTEMRA at no cost to financially eligible patients who meet the following criteria:

  • Are 65 years of age or over
  • Do not have commercial insurance
  • Do not qualify for co-pay assistance from a co-pay assistance foundation
  • Have not met the catastrophic coverage requirement of $4750 in out-of-pocket drug costs
  • Have not met the catastrophic coverage requirement of $6954.52 in total drug costs

Learn More About
ACTEMRA
  • LEARN about treatment with ACTEMRA
  • NOW AVAILABLE: ACTEMRA SC for
    self-injection
  • LEARN HOW the ACT Fast Program can help ACTEMRA SC patients awaiting a coverage decision.
  • Download: new forms for enrollment in GATCF
  • Form Statement of Medical Necessity
  • Form Patient Authorization and Notice of Release of Information

Actemra Indications and Important Safety Information

ACTEMRA INDICATIONS

ACTEMRA® (tocilizumab) is indicated for the treatment of adult patients with moderately to severely active rheumatoid arthritis (RA) who have had an inadequate response to one or more Disease-Modifying Anti-Rheumatic Drugs (DMARDs).

ACTEMRA is indicated for the treatment of active polyarticular juvenile idiopathic arthritis in patients 2 years of age and older.

ACTEMRA is indicated for the treatment of active systemic juvenile idiopathic arthritis in patients 2 years of age and older.

ACTEMRA IMPORTANT SAFETY INFORMATION

Patients treated with ACTEMRA are at increased risk for developing serious infections that may lead to hospitalization or death, including tuberculosis (TB), bacterial, invasive fungal, viral, or other opportunistic infections.

If a serious infection develops, interrupt ACTEMRA until the infection is controlled.

 

ACTEMRA is contraindicated in patients with known hypersensitivity to ACTEMRA. Hypersensitivity reactions, including anaphylaxis and death, have occurred.

  • If anaphylaxis or other hypersensitivity reaction occurs, stop administration of ACTEMRA immediately and discontinue ACTEMRA permanently.

Other serious or potentially life-threatening adverse reactions that have been reported in clinical trials with ACTEMRA include gastrointestinal perforations.

Other potential risks of ACTEMRA include demyelinating disorders and malignancies.

Laboratory monitoring is recommended due to potential consequences of treatment-related laboratory abnormalities in neutrophils, platelets, lipids, and liver function tests.

Common adverse reactions in RA studies included upper respiratory tract infections, nasopharyngitis, headache, hypertension, increased ALT, and injection-site reactions (SC only).

Common adverse reactions in SJIA studies included upper respiratory tract infections, headache, nasopharyngitis, and diarrhea.

In general, the types of adverse drug reactions in patients with PJIA were consistent with those seen in RA and SJIA patients.

You may report side effects to the FDA at (800) FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at (888) 835-2555.

Please see full Prescribing Information, including Boxed Warning for additional important safety information.

ACTEMRA® and its logo are trademarks of Chugai Seiyaku Kabushiki Kaisha Corp., a member of the Roche Group.

The Access Solutions logo is a registered trademark of Genentech, Inc.