Esbriet Coverage

Benefits Investigations

Esbriet 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

A BI may be initiated once the SMN and PAN are submitted to Esbriet 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

Esbriet Access Solutions 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 Esbriet Access Solutions.

If your patient’s request for a PA is not granted, your Pulmonology Field Reimbursement Manager (PFRM) or Esbriet 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.

Esbriet Start Now Program

With the Esbriet Start Now Program, eligible patients taking Esbriet may receive free medicine while awaiting an insurance coverage determination.

If you think your patient qualifies for the Esbriet Start Now Program, submit the completed SMN and PAN to Esbriet Access Solutions.

Eligible patients can receive a free supply of Esbriet for up to 30 days. Once coverage has been determined, the patient no longer qualifies for the Esbriet Start Now 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.