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.
For your patient to be eligible for help from GATCF, certain specific criteria must be met:
To determine if your patient qualifies, request a GATCF Eligibility Screening when you conduct the initial benefits investigation.
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.
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:
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.
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: