ACTEMRA Coverage

Benefits Investigations Prior Authorization Rheumatology Subsequent Verification Program (RSVP) ACT Fast Program

Benefits Investigations

ACTEMRA Access Solutions can conduct a benefits investigation (BI) to help you determine if a Genentech medicine is covered, if prior authorizations (PAs) are required, which specialty pharmacy (SP) the health insurance plan prefers and if financial assistance might be needed.

Potential outcomes of a BI:

Treatment is covered
PA is required
Treatment is denied

Both the Prescriber Service Form and the Patient Consent Form must be received before ACTEMRA Access Solutions can begin helping your patient.

These can be downloaded from Forms and Documents or submitted online via My Patient Solutions.

The completion and submission of coverage- or reimbursement-related documentation are the responsibility of the patient and health care provider. Genentech makes no representation or guarantee concerning coverage or reimbursement for any service or item.

Prior Authorization

ACTEMRA Access Solutions can help you identify if a prior authorization (PA) is necessary and offer resources as you request it for your patient. Both the Prescriber Service Form and the Patient Consent Form must be received before ACTEMRA Access Solutions can begin helping your patient.

If your patient’s request for a PA is not granted, your Field Reimbursement Manager (FRM) or ACTEMRA Access Solutions Specialist can work with you to determine your next steps. You can find more tips like this in Forms and Documents.

RSVP for ACTEMRA for Intravenous (IV) Infusion

When a medical treatment is authorized for a limited period of time, it will generally require reverification for coverage of continued treatment. ACTEMRA Access Solutions can help you obtain reverification for your patients.

Each year, you will receive a list of the ACTEMRA patients you have referred to ACTEMRA Access Solutions. You must review and select the patients for whom you wish to have a benefits investigation (BI) completed and send the list back to us. If you do not wish to use this service, you may opt out by checking the box on the enrollment form or by calling us directly.

You can download the enrollment form from Forms and Documents.

ACT Fast Program

With the ACT Fast Program, eligible patients taking ACTEMRA may receive free medicine while awaiting an insurance coverage determination.

If you think your patient qualifies for the ACT Fast Program, submit the completed Prescriber Service Form and the Patient Consent Form to ACTEMRA Access Solutions.

Eligible patients can receive a 14-day supply of ACTEMRA every 2 weeks for up to 6 months. Once coverage has been determined, the patient no longer qualifies for the ACT Fast Program.

Subject to eligibility requirements and terms and conditions. This program is void where prohibited by law and may not be used in or by residents of restricted states, if applicable.

For assistance, call (877) GENENTECH/(877) 436-3683
6 a.m.–5 p.m. PT, Monday through Friday

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