The Genentech® Access to Care Foundation (GATCF) was established to help patients who are uninsured—or who have been denied coverage for XOLAIR® (omalizumab) by their health plans. GATCF might be able to help those patients receive XOLAIR treatment if they meet specific financial and medical criteria.
For your patient to be eligible for help from GATCF, certain specific criteria must be met:
To apply to GATCF, the following forms must be completed and submitted in addition to the Statement of Medical Necessity (SMN) form and Patient Authorization and Notice of Release of Information (PAN) form.
When completing the SMN, be sure to complete all sections of the form.
Only the information requested on these forms is required. Providing additional documents or information will delay processing.
Once we receive your patient’s information, XOLAIR Access Solutions will contact the patient within 24 hours with further instructions. This might include verifying financial eligibility.
Additional GATCF program details: