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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 XELODA® (capecitabine) by their health plans. GATCF might be able to help those patients receive XELODA 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 XELODA
  • 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

 

 


 

 

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, XELODA Access Solutions will contact the patient within 24 hours with further instructions. This may include verifying financial eligibility.

 

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 XELODA only, not the administration costs

 

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

Learn More About
XELODA
  • LEARN about treatment with XELODA
  • FIND the right patient assistance program with our Compass for Patient Access tool
  • Form Statement of Medical Necessity
  • Form Patient Authorization and Notice of Release of Information

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