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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 Avastin® (bevacizumab) by their health plans. GATCF might be able to help those patients receive Avastin 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 Avastin
  • 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 our Forms and Documents.

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

 

 

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

 

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

 

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 Avastin only, not the administration costs

 

 


 

 

GATCF Eligibility Screening

If you have concerns about your patient’s insurance coverage for Avastin, 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 Avastin 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.

 

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 Avastin. This includes exhausting the appeals process. GATCF also needs to verify the medical and financial qualifications based on the documentation supplied by your patient.

 

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

Learn More About
Avastin
  • LEARN about treatment with Avastin
  • **Important Information Regarding Counterfeit Drug **
  • LEARN HOW the Genentech BioOncology Co-pay Card can help with the out-of-pocket costs for Avastin
  • Download: new forms for enrollment in GATCF
  • Form Statement of Medical Necessity
  • Form Patient Authorization and Notice of Release of Information

INDICATIONS

Glioblastoma (GBM)
Avastin is indicated for the treatment of glioblastoma as a single agent for adult patients with progressive disease following prior therapy. The effectiveness of Avastin in glioblastoma is based on an improvement in objective response rate. There are no data demonstrating an improvement in disease-related symptoms or increased survival with Avastin.

Metastatic colorectal cancer (MCRC)
Avastin is indicated for the first- or second-line treatment of patients with metastatic carcinoma of the colon or rectum in combination with intravenous 5-fluorouracil–based chemotherapy.

Avastin, in combination with fluoropyrimidine-irinotecan- or fluoropyrimidine-oxaliplatin-based chemotherapy, is indicated for the second-line treatment of patients with metastatic colorectal cancer who have progressed on a first-line Avastin-containing regimen.

Limitation of Use: Avastin is not indicated for adjuvant treatment of colon cancer.

Non-squamous non-small cell lung cancer (NSCLC)
Avastin is indicated for the first-line treatment of unresectable, locally advanced, recurrent or metastatic non–squamous non–small cell lung cancer in combination with carboplatin and paclitaxel.

Metastatic renal cell carcinoma (mRCC)
Avastin is indicated for the treatment of metastatic renal cell carcinoma in combination with interferon alfa.

Boxed WARNINGS

  • Gastrointestinal (GI) perforation

    - Serious and sometimes fatal GI perforation occurs at a higher incidence in Avastin-treated patients compared to controls

    - The incidences of GI perforation ranged from 0.3% to 2.4% across clinical studies

    - Discontinue Avastin in patients with GI perforation

  • Surgery and wound healing complications

    - The incidence of wound healing and surgical complications, including serious and fatal complications, is increased in Avastin-treated patients

    - Do not initiate Avastin for at least 28 days after surgery and until the surgical wound is fully healed. The appropriate interval between termination of Avastin and subsequent elective surgery required to reduce the risks of impaired wound healing/wound dehiscence has not been determined

    - Discontinue Avastin at least 28 days prior to elective surgery and in patients with wound healing complications requiring medical intervention

  • Hemorrhage

    - Severe or fatal hemorrhage, including hemoptysis, GI bleeding, hematemesis, central nervous system hemorrhage, epistaxis, and vaginal bleeding, occurred up to 5-fold more frequently in patients receiving Avastin. Across indications, the incidence of grade ≥3 hemorrhagic events among patients receiving Avastin ranged from 1.2% to 4.6%

    - Do not administer Avastin to patients with serious hemorrhage or recent hemoptysis (≥1/2 tsp of red blood)

    - Discontinue Avastin in patients with serious hemorrhage (ie, requiring medical intervention)

Additional serious adverse events

  • Additional serious and sometimes fatal adverse events with increased incidence in the Avastin-treated arm vs control included

    - Non-GI fistula formation (≤0.3%)

    - Arterial thromboembolic events (grade ≥3, 2.6%)

    - Proteinuria (nephrotic syndrome, <1%)

  • Additional serious adverse events with increased incidence in the Avastin-treated arm vs control included

    - Hypertension (grade 3–4, 5%–18%)

    - Reversible posterior leukoencephalopathy syndrome (RPLS) (<0.1%)

  • Infusion reactions with the first dose of Avastin were uncommon (<3%), and severe reactions occurred in 0.2% of patients
  • Inform females of reproductive potential of the risk of ovarian failure prior to starting treatment with Avastin

Most common adverse events

  • Across indications, the most common adverse reactions observed in Avastin patients at a rate >10% and at least twice the control arm rate were
    - Epistaxis - Proteinuria - Lacrimation disorder
    - Headache - Taste alteration - Back pain
    - Hypertension - Dry skin - Exfoliative dermatitis
    - Rhinitis - Rectal hemorrhage  
  • Across all studies, Avastin was discontinued in 8.4% to 21% of patients because of adverse reactions

Pregnancy warning

  • Avastin may impair fertility
  • Based on animal data, Avastin may cause fetal harm
  • Advise patients of the potential risk to the fetus during and following Avastin and the need to continue adequate contraception for at least 6 months following the last dose of Avastin
  • For nursing mothers, discontinue nursing or Avastin, taking into account the importance of Avastin to the mother

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 accompanying full Prescribing Information, including Boxed WARNINGS, for additional important safety information.

Avastin® and the Access Solutions logo are registered trademarks of Genentech, Inc.