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Help for Uninsured Patients

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.

 

 


 

 

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 XOLAIR
  • Your patient’s annual household adjusted gross income must be $100,000 or less (special consideration can be given to patients with unique circumstances)
  • Your patient must meet medical criteria

 

 


 

 

How do I get started?

To apply to GATCF, you must complete and submit the Statement of Medical Necessity and have your patient complete and submit a Patient Authorization and Notice of Release of Information form.

The Statement of Medical Necessity can be submitted online via My Patient Solutions or downloaded from Forms and Documents.

When completing the Statement of Medical Necessity, be sure to complete all sections of the form.

 

 

Once we receive your patient’s information, XOLAIR Access Solutions then contacts the patient within 24 hours with further instructions. This might include verifying financial eligibility.

 

Additional GATCF program details:

  • Patients are eligible for free medicine for 1 year and must reapply annually
  • Patient assistance support may be given before treatment or up to 1 year post-treatment
  • GATCF assists with the cost of XOLAIR 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
Xolair
  • LEARN about treatment with XOLAIR
  • FIND the right patient assistance program with our Compass for Patient Access tool
  • LEARN HOW the XOLAIR Co-pay Card Program may be able to help with the out-of-pocket costs for XOLAIR
  • Form Statement of Medical Necessity
  • Form Patient Authorization and Notice of Release of Information (Current Version)

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