ALECENSA Coverage
Benefits Investigations
ALECENSA 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 patient 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 ALECENSA 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
ALECENSA Access Solutions can help you identify if a prior
authorization (PA) is necessary and offer resources as you obtain it
for your patient. Both the Prescriber Service Form and the Patient
Consent Form must be received before ALECENSA Access Solutions can
begin helping your patient.
If your patient’s request for a PA is not granted, your Field Reimbursement Manager (FRM) or ALECENSA 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 Prescriber Service Form and the Patient Consent
Form to ALECENSA Access Solutions.
Eligible patients can receive a 30-day supply of ALECENSA. Once coverage has been determined, the patient no longer qualifies for the SureStart 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.
