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.
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.
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
How Do I Get My Patient Started?
To apply for GATCF, submit the completed SMN and PAN to Genentech
BioOncology® Access Solutions for COTELLIC and ZELBORAF. Patients must
complete Section 6 of the PAN to apply for GATCF.
If needed, additional GATCF-specific forms may also be requested. You can download them by selecting the button below.
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
COTELLIC (cobimetinib) is indicated for the treatment of patients with unresectable or metastatic melanoma with a BRAF V600E or V600K mutation, in combination with ZELBORAF (vemurafenib).
Important Safety Information
WARNINGS AND PRECAUTIONS
Review the Full Prescribing Information for ZELBORAF for information on the serious risks of ZELBORAF.
The following can occur in patients treated with COTELLIC:
- New primary malignancies, including cutaneous and non-cutaneous malignancies
- Hemorrhage, including major hemorrhages
- Cardiomyopathy, defined as symptomatic and asymptomatic decline in left ventricular ejection fraction
- Severe dermatologic reactions, including rash and other skin reactions
- Serous retinopathy and retinal vein occlusion
- Severe photosensitivity
- Embryo-fetal toxicity
USE IN SPECIFIC POPULATIONS: Lactation
Do not breastfeed while taking COTELLIC and for 2 weeks after the final dose.
Avoid concomitant administration of COTELLIC with strong or moderate CYP3A inducers or inhibitors.
Most Common Adverse Reactions
The most common (≥20%) adverse reactions with COTELLIC were diarrhea (60%), photosensitivity reaction (46%), nausea (41%), pyrexia (28%), and vomiting (24%). The most common (≥5%) Grade 3-4 laboratory abnormalities were increased GGT (21%), increased CPK (14%), hypophosphatemia (12%), increased ALT (11%), lymphopenia (10%), increased AST (8%), increased alkaline phosphatase (7%), and hyponatremia (6%).
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 Full COTELLIC Prescribing Information for additional Important Safety Information.