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Co-pay Assistance Foundations Referring a Patient to a Co-pay Assistance Foundation

If your patients need help with their medication co-pays, PERJETA Access Solutions can connect them to co-pay assistance foundations* supporting their disease state.

 

Listing of Co-Pay Assistance Foundations

Select from the available disease states below for a list of foundations.This information is updated regularly.

  •  Breast Cancer
    • Chronic Disease Fund
      6900 N. Dallas Parkway, Suite 200
      Plano, TX 75024
      Toll Free: 1-877-968-7233
      www.cdfund.org



      NOTE: Per CDF's policy, they only cover first-line treatment medications. Xeloda breast cancer patients are not covered. If you have further questions, please call CDF.

    • Patient Advocate Foundation (PAF)
      421 Butler Farm Road
      Hampton, VA 23666
      Toll Free: 866-512-3861
      www.patientadvocate.org



    • Patient Access Network Foundation (PANF)
      P.O. Box 221858
      Charlotte, NC 28222-1858
      Toll Free: 866-316-PANF (7263)
      www.panfoundation.org



      NOTE: PANF is only covering metastatic breast cancer Medicare patients

* Genentech does not influence or control the operations of these co-pay assistance foundations, but PERJETA Access Solutions can assist patients by making an appropriate referral to a foundation that may be able to help. We cannot guarantee co-pay assistance once a patient has been referred by PERJETA Access Solutions. The foundations to which we refer patients each have their own criteria for patient eligibility, including financial eligibility.
Learn More About
PERJETA
  • LEARN about treatment with PERJETA
  • LEARN HOW the Genentech BioOncology Co-pay Card can help with the out-of-pocket costs for PERJETA
  • Download: new forms for enrollment in GATCF
  • Form Statement of Medical Necessity
  • Form Patient Authorization and Notice of Release of Information

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