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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.

 

 

 

Key points to remember about co-pay assistance foundations:


  • For some foundations, approval can occur in less than 30 days with possible contingent approval sooner
  • If the patient is denied assistance by one foundation, he or she can be referred to a different foundation, if one is available
  • Although each foundation offers some form of assistance, it might not be a full award
  • The application process might require some form of financial verification
  • All aspects of application processing can vary by foundation and are determined by each foundation
  • Patients should be sure to submit the application and required documentation in a timely manner to avoid delays or gaps in coverage

 

* Genentech does not influence or control the operations of these co-­-pay assistance foundations, but PERJETA Access Solutions can assist patients in navigating the process of seeking co-­-pay assistance by making an appropriate referral based on a patient’s diagnosis and by assisting with the application process. 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.

 


 

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

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

PERJETA Indication and Important Safety Information

INDICATION

PERJETA® (pertuzumab) is a HER2/neu receptor antagonist indicated for:

  • Treatment of metastatic breast cancer in combination with Herceptin® (trastuzumab) and docetaxel for the treatment of patients with HER2-positive metastatic breast cancer who have not received prior anti-HER2 therapy or chemotherapy for metastatic disease
  • Use in combination with trastuzumab and docetaxel as neoadjuvant treatment of patients with HER2-positive, locally advanced, inflammatory, or early stage breast cancer (either greater than 2 cm in diameter or node positive) as part of a complete treatment regimen for early breast cancer. This indication is based on demonstration of an improvement in pathological complete response rate. No data are available demonstrating improvement in event-free survival or overall survival

Limitations of Use:

  • The safety of PERJETA as part of a doxorubicin-containing regimen has not been established
  • The safety of PERJETA administered for greater than 6 cycles for early breast cancer has not been established

Important Safety Information

Boxed WARNINGS: Cardiomyopathy and Embryo-Fetal Toxicity

  • PERJETA administration can result in subclinical and clinical cardiac failure. Evaluate left ventricular function in all patients prior to and during treatment with PERJETA. Discontinue PERJETA treatment for a confirmed clinically significant decrease in left ventricular function
  • Exposure to PERJETA can result in embryo-fetal death and birth defects. Studies in animals have resulted in oligohydramnios, delayed renal development, and death. Advise patients of these risks and the need for effective contraception

Additional Important Safety Information

  • PERJETA is contraindicated in patients with known hypersensitivity to pertuzumab or to any of its excipients
  • PERJETA has been associated with infusion and hypersensitivity reactions/anaphylaxis
  • Detection of HER2 protein overexpression is necessary for selection of patients appropriate for PERJETA therapy
  • In the treatment of MBC, the most common adverse reactions (>30%) seen with PERJETA in combination with Herceptin and docetaxel were diarrhea, alopecia, neutropenia, nausea, fatigue, rash, and peripheral neuropathy

Most Common Adverse Reactions in Neoadjuvant Treatment of Breast Cancer:

  • The most common adverse reactions (>30%) with PERJETA in combination with trastuzumab and docetaxel were alopecia, diarrhea, nausea, and neutropenia
  • The most common adverse reactions (>30%) with PERJETA in combination with trastuzumab and docetaxel when given for 3 cycles following 3 cycles of FEC were fatigue, alopecia, diarrhea, nausea, vomiting, and neutropenia
  • The most common adverse reactions (>30%) with PERJETA in combination with docetaxel, carboplatin, and trastuzumab (TCH) were fatigue, alopecia, diarrhea, nausea, vomiting, neutropenia, thrombocytopenia, and anemia

You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

You may also report side effects to Genentech at 1-888-835-2555

Please see PERJETA full Prescribing Information including Boxed WARNINGS for additional Important Safety Information.

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