ALECENSA Coverage
Benefits Investigations
Genentech BioOncology® Access Solutions for ALECENSA 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
patient assistance might be needed.
Potential outcomes of a BI:
- Treatment is covered
- PA is required
- Treatment is denied
A BI may be initiated once the SMN and PAN are submitted to
Genentech BioOncology Access Solutions.
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
Genentech BioOncology® Access Solutions for ALECENSA can help you
identify if a prior authorization (PA) is necessary and offer
resources as you obtain it for your patient. PA support may be
provided once the SMN and PAN are submitted to Genentech BioOncology
Access Solutions.
If your patient’s request for a PA is not granted, your BioOncology Field Reimbursement Manager (BFRM) or Genentech BioOncology Access Solutions Specialist can work with you to determine your next steps. You can find more tips like this in Forms and Documents.
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.
SureStart® Program
With the SureStart Program, eligible patients taking ALECENSA may receive free medicine while awaiting an insurance coverage determination.
If you think your patient qualifies for the SureStart Program,
submit the completed SMN and PAN to Genentech BioOncology® Access
Solutions for ALECENSA.
Eligible patients can receive a 30-day supply of ALECENSA. Once coverage has been determined, the patient no longer qualifies for the SureStart Program.
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.