Genentech® Access to Care Foundation (GATCF)
GATCF helps eligible patients who meet specific criteria receive
Genentech medicines free of charge.
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 their Genentech medicine?
Your Patient Appears to be Eligible for GATCF
To confirm your patient’s eligibility for free medicine from GATCF, enroll your patient in Esbriet Access Solutions. Remember to:
- Check the GATCF box in the Services Requested section when completing the Statement of Medical Necessity (SMN)
- Remind your patient to complete Section 6 of the Patient Authorization and Notice of Release of Information (PAN)
These sections must be complete on these forms to enroll your patient in GATCF.
Click here to go to the Forms and Documents page to download the SMN and PAN forms.
Your Patient Does Not Appear to be Eligible for GATCF, but Other Options May Be Available
Genentech offers options to help eligible patients with the OOP costs of their Genentech medicines.
Use the Patient Assistance Tool or call Esbriet Access Solutions at (844) 372-7438 to find out which option may be right for your patient.
To be eligible for free medicine from GATCF, insured patients must have exhausted all other forms of patient assistance (including Genentech brand-specific co-pay cards and support from independent co-pay assistance foundations) and meet additional criteria.
Download this flash card to view a summary of GATCF eligibility and
How Do I Get My Patient Started?
Complete and submit enrollment forms and submit them to Esbriet Access Solutions:
- Statement of Medical Necessity (SMN)
- Patient Authorization and Notice of Release of Information (PAN)
When completing the SMN, be sure to complete all sections of the form.
Only the information requested on these forms is required. Providing additional documents or information will delay processing.
Once we receive your patient’s information, Esbriet Access Solutions
will contact the patient within 24 hours with further instructions.
This may include verifying financial eligibility.