Referrals to the Genentech® Access to Care Foundation (GATCF)

GATCF provides free medicine to eligible patients who are uninsured, rendered uninsured by payer denial or underinsured. To qualify, patients must meet financial criteria.

Is My Patient Eligible?

  • Does your patient have health insurance?

  • Is your patient’s annual household adjusted gross income (AGI) less than $100,000?

  • Is your patient’s annual household adjusted gross income (AGI) less than $150,000?

  • Does your patient spend 5% or more of his or her annual household AGI on the out-of-pocket costs for his or her Genentech medicine?

Your Patient Appears to Be Eligible for GATCF

To get started with GATCF, complete and submit the SMN and PAN to Genentech BioOncology® Access Solutions. Patients must complete Section 6 of the PAN to apply for GATCF.

Download the Forms

Your Patient Does Not Appear to Be Eligible for GATCF, but Other Options May Be Available

Several options are available to help eligible patients with the out-of-pocket costs of their Genentech medicines.

Call Genentech BioOncology® Access Solutions at (888) 249-4918 or use our Patient Assistance Tool to find out which option may be right for your patient.

Use the Patient Assistance Tool

To be eligible for free Genentech medicine from GATCF, insured patients must have exhausted all other forms of patient assistance (including the Genentech BioOncology Co-pay Card and support from independent co-pay assistance foundations) and meet financial criteria. Uninsured patients must meet different financial criteria.

Download this flash card to view a summary of GATCF eligibility and enrollment information.

How Do I Get My Patient Started?

To apply for GATCF, submit the completed SMN and PAN to Genentech BioOncology® Access Solutions for ALECENSA. Patients must complete Section 6 of the PAN to apply for GATCF.

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

Only the information requested on these forms is required. Providing additional documents or information will delay processing.

Once we receive your patient’s information, Genentech BioOncology Access Solutions will contact the patient with further instructions. This may include verifying financial eligibility.

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

Indication

ALECENSA is indicated for the treatment of patients with anaplastic lymphoma kinase (ALK)-positive metastatic non-small cell lung cancer (mNSCLC) as detected by an FDA- approved test.

Important Safety Information

Hepatotoxicity: Monitor liver function tests every 2 weeks during the first 3 months of treatment, then once a month and as clinically indicated, with more frequent testing in patients who develop transaminase and bilirubin elevations. Based on the severity of the adverse reaction, withhold then dose reduce, or permanently discontinue ALECENSA.

Interstitial Lung Disease (ILD)/Pneumonitis: ILD/pneumonitis occurred in 0.7% of patients. Immediately withhold ALECENSA in patients diagnosed with ILD/pneumonitis and permanently discontinue if no other potential causes of ILD/pneumonitis have been identified.

Renal Impairment: Renal impairment occurred in 8% of patients. Incidence of Grade ≥3 was 1.7%, of which 0.5% were fatal events. Based on the severity of the adverse reaction, withhold then dose reduce, or permanently discontinue ALECENSA.

Bradycardia: Monitor heart rate and blood pressure regularly. If symptomatic, withhold ALECENSA then dose reduce or permanently discontinue.

Severe Myalgia and Creatine Phosphokinase (CPK) Elevation: Advise patients to report any unexplained muscle pain, tenderness, or weakness. Assess CPK levels every 2 weeks for the first month of treatment and as clinically indicated in patients reporting symptoms. Based on the severity of the CPK elevation, withhold, then resume or dose reduce ALECENSA.

Embryo-Fetal Toxicity: ALECENSA can cause fetal harm. Advise pregnant women of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with ALECENSA and for 1 week following the final dose. Advise males with female partners of reproductive potential to use effective contraception during treatment with ALECENSA and for 3 months following the final dose.

Most Common Adverse Reactions: The most common adverse reactions (incidence ≥20%) were constipation (34%), fatigue (26%), myalgia (23%), edema (22%), and anemia (20%).

You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at 1-888-835-2555.

Please see additional Important Safety Information in full Prescribing Information.