¿Cómo Podemos Ayudarle?

Puede haber opciones para ayudarle a cubrir los gastos de sus medicamentos de Genentech, independientemente del tipo de seguro médico que posea.

Derivación a Fundaciones Independientes de Asistencia al Copago

Si necesita ayuda con el copago de su medicamento de Genentech, ZELBORAF Access Solutions puede derivarle a una fundación independiente de asistencia al copago.

Una fundación independiente de asistencia al copago es una organización benéfica que proporciona asistencia financiera para medicamentos.

Llame a ZELBORAF Access Solutions en el (888) 249-4918 para que le deriven.

Si desea ponerse en contacto directamente con una fundación, puede usar la información que se indica a continuación:

The HealthWell Foundation
P.O. Box 220410
Chantilly, VA 20153-0410
Toll Free: 1-800-675-8416
www.healthwellfoundation.org

Patient Access Network Foundation (PANF)
P.O. Box 221858
Charlotte, NC 28222-1858
Toll Free: 1-866-316-PANF (7263)
www.panfoundation.org

The Assistance Fund, Inc.
4700 Millenia Boulevard, Suite 410
Orlando, FL 32839
Toll Free: 1-855-845-3663
https://theassistancefund.org

La fundaciones independientes de asistencia al copago tienen sus propias normas para elegibilidad. No podemos garantizarle que una fundación le vaya a ayudar. Solo podemos derivarle para que esta le asista con su estado de salud. Esta información solo se la proporcionamos a modo informativo. No respaldamos ni mostramos preferencia económica por ninguna fundación en particular. Las fundaciones de esta lista no son las únicas que pueden ayudarle.

Derivaciones a la fundación Genentech® Access to Care Foundation

La fundación Genentech® Access to Care Foundation, o GATCF, puede ayudarle a conseguir su medicamento de Genentech de forma gratuita si cumple los requisitos.

La GATCF ayuda a las personas que:

  • No tienen seguro—personas que no cuentan con un seguro
  • Se consideran sin seguro—personas cuyo seguro médico no cubre el medicamento de Genentech
  • Tienen un seguro insuficiente—personas que tienen un seguro médico (incluidos planes de seguro comerciales o públicos), pero pagan más de un importe determinado por los medicamentos al año

Se deben cumplir otros criterios de elegibilidad para poder recibir medicamentos gratis a través de la GATCF. Si cumple los requisitos indicados a continuación, puede que sea apto para recibir ayuda.

  • ¿Tiene seguro médico?

  • ¿Los ingresos anuales de su hogar son inferiores a $100,000?

  • ¿Los ingresos anuales de su hogar son inferiores a $150,000?

  • ¿Gasta un 5% o más de los ingresos anuales del hogar en costos del bolsillo en medicamentos de Genentech?

Podría reunir los requisitos para recibir medicamentos gratis a través de la GATCF

Para solicitar asistencia de la GATCF, debe cumplimentar el formulario PAN y la consulta de su médico debe cumplimentar el formulario SMN.

Asegúrese de rellenar los apartados 5 y 6 del formulario PAN.

Descargar el SMN y el PAN

Puede Haber Disponibles Otras Opciones

Parece que no reúne los requisitos para recibir medicamentos gratis a través de la GATCF. No obstante, puede que haya otras opciones de asistencia para ayudarle.

Averigüe Qué Opción Puede Ser la Adecuada para Usted

También puede llamar a ZELBORAF Access Solutions en el (888) 249-4918 y hablar con uno de nuestros Especialistas.

Tendrá que rellenar los apartados 5 y 6 del formulario PAN para solicitar asistencia a la GATCF.

Si cuenta con un seguro médico, primero debe haber probado otros tipos de asistencia a pacientes para ser apto para recibir medicamentos gratis de Genentech a través de la GATCF. Esto incluye la Tarjeta de Copago de Genentech BioOncology y la ayuda de fundaciones independientes de asistencia al copago. También debe cumplir otros criterios financieros. Si no tiene seguro, debe cumplir unos criterios financieros diferentes.

Derivaciones a la Tarjeta de Copago de Genentech BioOncology

ZELBORAF Access Solutions puede derivarle a la Tarjeta de Copago de Genentech BioOncology. Si usted es elegible, puede ayudarle con los gastos de los medicamentos de Genentech que deba abonar de su bolsillo.

La Tarjeta de Copago de Genentech BioOncology ayuda a los pacientes con un seguro médico comercial. Puede que sea un plan que obtiene a través de su empleador o uno que haya contratado en un Mercado de Seguros Médicos como HealthCare.gov. Para poder calificar, también debe cumplir otros criterios.

Para poder optar a la Tarjeta de Copago de Genentech BioOncology, el paciente debe disponer de un seguro comercial, no debe tener Medicare, Medicaid ni ningún otro seguro público y debe cumplir otros criterios de elegibilidad. También debe aceptar las reglas establecidas en los términos y condiciones del programa. Visite CopayAssistanceNow.com para ver la lista completa de términos y condiciones.

Cómo Trabajar con ZELBORAF Access Solutions

Paso 1

Suscríbase a ZELBORAF Access Solutions.

¿Cómo me inscribo?

Paso 2

Trabajamos con usted, con la consulta de su médico, su plan de seguro médico y su farmacia especializada. Podríamos ponernos en contacto con usted para recabar más información.

¿Qué averiguaremos?

Paso 3

Le derivamos a las opciones de asistencia a pacientes.

¿Qué opciones hay?

PAN=siglas en inglés de Autorización del Paciente y Aviso de Solicitud Para Transmitir Información Médica a Genentech Access Solutions y a Genentech® Access to Care Foundation.

SMN=siglas en inglés de Declaración de Necesidad Médica.

Important Safety Information & Indication

What it Treats

What is ZELBORAF APPROVED FOR?

ZELBORAF is a prescription medicine used to treat a type of skin cancer called melanoma that has spread to other parts of the body or cannot be removed by surgery, and that has a certain type of abnormal “BRAF” gene.

ZELBORAF is not used to treat melanoma with a normal BRAF gene.
Your healthcare provider will perform a test to make sure ZELBORAF is right for you.

ZELBORAF is a prescription medicine used to treat a type of blood cell cancer called Erdheim–Chester disease (ECD), that can affect body tissues and organs, and that has a certain type of abnormal “BRAF” gene.

It is not known if ZELBORAF is safe and effective in children under 18 years of age.

Important Safety Information

What is the most important information I should know about ZELBORAF?

ZELBORAF can cause serious side effects, including:

  • Risk of new cancers. ZELBORAF may cause certain types of skin cancer called cutaneous squamous cell carcinoma (cuSCC) and keratoacanthoma. New melanoma lesions have occurred in people who take ZELBORAF. ZELBORAF may also cause another type of cancer called non-cutaneous squamous cell carcinoma (non-cuSCC). Talk with your healthcare provider about your risk for these cancers.

Check your skin and tell your healthcare provider right away about any skin changes, including:

  • A new wart
  • A skin sore or reddish bump that bleeds or does not heal
  • A change in size or color of a mole

Your healthcare provider should check your skin before you start taking ZELBORAF, and every 2 months during treatment with ZELBORAF, to look for any new skin cancers. Your healthcare provider may continue to check your skin for 6 months after you stop taking ZELBORAF.

Your healthcare provider should also check for cancers that may not occur on the skin. Tell your healthcare provider about any new symptoms that you get while taking ZELBORAF.

Other blood cancers have happened in some people with Erdheim-Chester Disease (ECD) including those who take ZELBORAF. If you have other blood cancers and take ZELBORAF for ECD, your healthcare provider will monitor your blood cancer through routine blood tests.

Before you take ZELBORAF, tell your healthcare provider about all of your medical conditions, including if you:

  • Have any heart problems, including a condition called long QT syndrome
  • Have liver or kidney problems
  • Have had or are planning to receive radiation therapy
  • Have been told that you have low blood levels of potassium, calcium, or magnesium
  • Are pregnant or plan to become pregnant. ZELBORAF can harm your unborn baby.
  • Females who are able to become pregnant should use effective birth control during treatment with ZELBORAF and for 2 weeks after the final dose of ZELBORAF
  • Talk to your healthcare provider about birth control methods that may be right for you
  • Tell your healthcare provider right away if you become pregnant during treatment with ZELBORAF
  • Are breastfeeding or plan to breastfeed. It is not known if ZELBORAF passes into your breast milk. Do not breastfeed during treatment with ZELBORAF and for 2 weeks after the final dose of ZELBORAF. Talk to your healthcare provider about the best way to feed your baby during this time.

Tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

What should I avoid while taking ZELBORAF?

Avoid sunlight during treatment with ZELBORAF. ZELBORAF can make your skin sensitive to sunlight. You may burn more easily and get severe sunburns. To help protect against sunburn:

  • When you go outside, wear clothes that protect your skin, including your head, face, hands, arms, and legs.
  • Use lip balm and a broad-spectrum sunscreen with SPF 30 or higher.

What are the possible side effects of ZELBORAF?

  • Allergic reactions can happen while taking your ZELBORAF, and can be severe. Stop taking ZELBORAF and get medical help right away if you get any of these symptoms of an allergic reaction:
    • Rash or redness all over your body
    • Trouble breathing or swallowing
    • Swelling of the face, lips, or tongue
    • Throat tightness or hoarseness
    • Feel faint
    • Fast heartbeat
  • Severe skin reactions. Stop taking ZELBORAF and call your healthcare provider right away if you get a skin rash with any of the following symptoms, because you may have a severe skin reaction:
    • Blisters on your skin
    • Blisters or sores in your mouth
    • Peeling of your skin
    • Fever
    • Redness or swelling of your face, hands, or soles of your feet
  • Changes in the electrical activity of your heart called QT prolongation. QT prolongation can cause irregular heartbeats that can be life-threatening. Your healthcare provider should do tests before you start taking ZELBORAF and during your treatment with ZELBORAF to check the electrical activity of your heart and your and your body salts (electrolytes). Tell your healthcare provider right away if you feel faint, lightheaded, dizzy, or feel your heart beating irregularly or fast while taking ZELBORAF. These may be symptoms related to QT prolongation.
  • Liver injury. Your healthcare provider should do blood tests to check your liver function before you start taking ZELBORAF and during treatment. Tell your healthcare provider right away if you get any of these symptoms of a liver problem during treatment:
    • Yellowing of your skin or the white part of your eyes
    • Dark or brown (tea color) urine
    • Nausea or vomiting
    • Loss of appetite
    • Pain on the right side of your stomach
  • Eye problems. Tell your healthcare provider right away if you get any of these symptoms during treatment with ZELBORAF:
    • Eye pain, swelling, or redness
    • Blurred vision or other vision changes
  • Worsening side effects from radiation treatment that can sometimes be severe or lead to death. Tell your healthcare provider if you have had or are planning to receive radiation therapy.
  • Kidney injury. Your healthcare provider should do blood tests to check your kidney function before you start taking ZELBORAF and during treatment.
  • Connective tissue disorders. Tell your healthcare provider if you develop an unusual thickening of the palms of your hands along with tightening of the fingers inward or any unusual thickening of the soles of your feet which may be painful.

The most common side effects of ZELBORAF in melanoma include:

  • Joint pain
  • Rash (see “Severe skin reactions” above)
  • Hair loss
  • Sunburn or sun sensitivity
  • Nausea
  • Itching
  • Warts

The most common side effects of ZELBORAF in Erdheim-Chester Disease include:

  • Joint pain
  • Tiredness
  • Hair loss
  • QT prolongation (see “Changes in the electrical activity of your heart called QT prolongation” above)

These are not all of the possible side effects of ZELBORAF. Call your doctor for medical advice about side effects.

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.

Please see accompanying Full Prescribing Information and Medication Guide for additional Important Safety Information.