GATCF helps eligible patients who meet specific insurance, financial and medical criteria receive their Genentech medicines free of charge.
Download this PDF file to view more information on eligibility criteria.
- For uninsured patients only
- Serves as proof that the patient's insurance will not cover the prescribed Genentech therapy
- For office-administered products only
- Completed after each infusion or injection
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.