Referrals to Independent Co-pay Assistance Foundations
An independent co-pay assistance foundation is a charitable
organization providing financial assistance to patients with specific
disease states. Genentech Rheumatology Access Solutions offers
referrals to independent co-pay assistance foundations for eligible
patients who are commercially or publicly insured, including those
covered by Medicare and Medicaid.
Listing of Independent Co-pay Assistance Foundations
Select from the available disease states below for a list of foundations. This information is updated regularly.
Moderate-to-Severe Rheumatoid Arthritis
No funds are available at this time.
Please call Genentech Rheumatology Access Solutions at (866) 681-3261. We may be able to help.
Giant Cell Arteritis
Genentech does not influence or control the operations or eligibility criteria of any independent co-pay assistance foundation and cannot guarantee co-pay assistance after a referral from Genentech Rheumatology Access Solutions. This information is provided as a resource to patients. Please note that this list is not indicative of Genentech's endorsement or financial support of any particular disease area and/or foundation, nor is it exhaustive. There may be other foundations to support the patient’s disease state.
PAN=Patient Authorization and Notice of Request
for Transmission of Health Information to Genentech Access Solutions
and Genentech® Access to Care Foundation.
SMN=Statement of Medical Necessity.
Important Safety Information & Indication
ACTEMRA is indicated for the treatment of adult patients with moderately to severely active rheumatoid arthritis (RA) who have had an inadequate response to one or more Disease-Modifying Anti-Rheumatic Drugs (DMARDs).
ACTEMRA is indicated for the treatment of giant cell arteritis (GCA) in adult patients.
ACTEMRA is indicated for the treatment of active polyarticular juvenile idiopathic arthritis in patients 2 years of age and older.
ACTEMRA is indicated for the treatment of active systemic juvenile idiopathic arthritis in patients 2 years of age and older.
BOXED WARNING and Additional Important Safety Information
RISK OF SERIOUS INFECTIONS:
Patients treated with ACTEMRA are at increased risk for developing serious infections that may lead to hospitalization or death, including tuberculosis (TB), bacterial, invasive fungal, viral, or other opportunistic infections. If a serious infection develops, interrupt ACTEMRA until the infection is controlled.
Reported infections include:
- Active tuberculosis, which may present with pulmonary or extrapulmonary disease. Patients should be tested for latent tuberculosis before ACTEMRA use and during therapy. Treatment for latent infection should be initiated prior to ACTEMRA use.
- Invasive fungal infections, including candidiasis, aspergillosis, and pneumocystis. Patients with invasive fungal infections may present with disseminated, rather than localized, disease.
- Bacterial, viral and other infections due to opportunistic pathogens.
The risks and benefits of treatment with ACTEMRA should be carefully considered prior to initiating therapy in patients with chronic or recurrent infection.
Patients should be closely monitored for the development of signs and symptoms of infection during and after treatment with ACTEMRA, including the possible development of tuberculosis in patients who tested negative for latent tuberculosis infection prior to initiating therapy.
ACTEMRA is contraindicated in patients with known hypersensitivity to ACTEMRA.
Other serious or potentially life-threatening adverse reactions that have been reported in clinical trials with ACTEMRA include gastrointestinal perforations. Use ACTEMRA with caution in patients who may be at risk for GI perforations.
Laboratory monitoring is recommended due to potential consequences of treatment-related laboratory abnormalities in neutrophils, platelets, lipids, and liver function tests.
Hypersensitivity reactions, including anaphylaxis and death, have occurred.
- If anaphylaxis or other hypersensitivity reaction occurs, stop administration of ACTEMRA immediately and discontinue ACTEMRA permanently.
Avoid use of live vaccines concurrently with ACTEMRA, as clinical safety has not been established.
Other potential risks of ACTEMRA include demyelinating disorders and malignancies. Treatment with ACTEMRA is not recommended in patients with active hepatic disease or hepatic impairment.
Most common adverse reactions (≥ 5%) include upper respiratory tract infections, nasopharyngitis, headache, hypertension, increased ALT, injection site reactions (SC only).
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, including BOXED WARNING, for additional important safety information.