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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, Tarceva® 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 is 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 and Astellas Pharmaceuticals does not influence or control the operations of these co-pay assistance foundations, but Tarceva 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 Tarceva 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.

  •  Advanced Non-Small Cell Lung Cancer
    • 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 advanced non-small cell lung cancer Medicare patients

  •  Pancreatic Cancer
    • CancerCare Co-Payment Assistance Foundation
      275 Seventh Avenue, 22nd Floor
      New York, NY 10001
      Toll Free: 1-866-55-COPAY (866-552-6729)
      www.cancercarecopay.org

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

Learn More About
Tarceva
  • LEARN about treatment with Tarceva
  • NOW APPROVED as first-line therapy for metastatic non–small cell lung cancer (NSCLC) patients with exon 19 and 21 epidermal growth factor receptor (EGFR) mutations.
  • LEARN HOW the Genentech BioOncology Co-pay Card can help with the out-of-pocket costs for Tarceva
  • Download: new forms for enrollment in GATCF
  • Form Statement of Medical Necessity
  • Form Patient Authorization and Notice of Release of Information

Tarceva Indications and Important Safety Information

INDICATIONS

Advanced Non-Small Cell Lung Cancer (NSCLC)
Tarceva is indicated for:

  • The first-line treatment of patients with metastatic NSCLC whose tumors have epidermal growth factor receptor (EGFR) exon 19 deletions or exon 21 (L858R) substitution mutations as detected by an FDA-approved test.
  • The maintenance treatment of patients with locally advanced or metastatic NSCLC whose disease has not progressed after four cycles of platinum-based first-line chemotherapy.
  • The treatment of patients with locally advanced or metastatic NSCLC after failure of at least one prior chemotherapy regimen.

Limitations of use:

  • Tarceva is not recommended for use in combination with platinum-based chemotherapy.
  • Safety and efficacy of Tarceva have not been evaluated as first-line treatment in patients with metastatic NSCLC whose tumors have EGFR mutations other than exon 19 deletions or exon 21 (L858R) substitution.

Advanced Pancreatic Cancer

  • Tarceva in combination with gemcitabine is indicated for the first-line treatment of patients with locally advanced, unresectable, or metastatic pancreatic cancer

Important safety information

    • CONTRAINDICATIONS: None
    • WARNINGS AND PRECAUTIONS:

- Cases of serious interstitial lung disease (ILD), including fatal cases, have been reported.

- Hepatic failure, hepatorenal syndrome, and severe acute renal failure (all including fatal cases) and renal insufficiency have been reported.

- Gastrointestinal perforation (including fatal cases) has been reported.

- Bullous, blistering and exfoliative skin conditions, including cases suggestive of Stevens-Johnson syndrome/toxic epidermal necrolysis, which in some cases were fatal, have been reported.

- In the pooled incidences in the 3 monotherapy lung studies and the pancreatic carcinoma trial, serious adverse reactions, including fatal cases, such as myocardial infarction/ischemia, cerebrovascular accident, and microangiopathic hemolytic anemia with thrombocytopenia were reported.

- Corneal perforation or ulceration have been reported.

- Severe and fatal hemorrhage associated with INR elevations can occur when Tarceva and warfarin are used concurrently.

- Embryo-fetal toxicity. Tarceva is pregnancy category D. Women should be advised to avoid pregnancy or breastfeeding.

  • MOST COMMON ADVERSE REACTIONS:

- Metastatic NSCLC – First-Line Treatment of Patients With EGFR Mutations:

- Diarrhea, asthenia, rash, cough, dyspnea, and decreased appetite.

- Advanced NSCLC – Maintenance and Second/Third-Line Treatment:

- Rash and diarrhea.

- Advanced Pancreatic Cancer – Tarceva Administered Concurrently with Gemcitabine:

- Fatigue, rash, nausea, anorexia, and diarrhea.

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.

For additional Important Safety Information, please see accompanying full prescribing information.

Tarceva® and its logo are trademarks of OSI Pharmaceuticals, LLC, an affiliate of Astellas Pharma US, Inc.

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