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ACTEMRA® (tocilizumab)‎ ALECENSA® (alectinib) Avastin® (bevacizumab) COTELLIC® (cobimetinib) ENSPRYNG™ (satralizumab-mwge) Erivedge® (vismodegib) Esbriet® (pirfenidone) Evrysdi® (risdiplam) GAVRETO® (pralsetinib) GAZYVA® (obinutuzumab) HEMLIBRA® (emicizumab-kxwh) Herceptin® (trastuzumab) Herceptin HYLECTA™ (trastuzumab and hyaluronidase-oysk) KADCYLA® (ado-trastuzumab emtansine) LUCENTIS® (ranibizumab injection) LUNSUMIO™ (mosunetuzumab-axgb) OCREVUS® (ocrelizumab) PERJETA® (pertuzumab) PHESGO™ (pertuzumab, trastuzumab, and hyaluronidase-zzxf) POLIVY® (polatuzumab vedotin-piiq) Pulmozyme® (dornase alfa) Inhalation Solution Rituxan® (rituximab) for Rheumatoid Arthritis (RA) RITUXAN® (rituximab) for Oncology Rituxan® (rituximab) for Granulomatosis with Polyangiitis (GPA), Microscopic Polyangiitis (MPA) or Pemphigus Vulgaris (PV) RITUXAN HYCELA® (rituximab/hyaluronidase human) ROZLYTREK® (entrectinib) SUSVIMO™ (ranibizumab injection) TECENTRIQ® (atezolizumab) VABYSMO® (faricimab-svoa) VENCLEXTA® (venetoclax tablets) XOLAIR® (omalizumab) for subcutaneous use ZELBORAF® (vemurafenib) Oncology Ophthalmology Rheumatology

ACTEMRA® (tocilizumab)‎ ALECENSA® (alectinib) Avastin® (bevacizumab) COTELLIC® (cobimetinib) ENSPRYNG™ (satralizumab-mwge) Erivedge® (vismodegib) Esbriet® (pirfenidone) Evrysdi® (risdiplam) GAVRETO® (pralsetinib) GAZYVA® (obinutuzumab) HEMLIBRA® (emicizumab-kxwh) Herceptin® (trastuzumab) Herceptin HYLECTA™ (trastuzumab and hyaluronidase-oysk) KADCYLA® (ado-trastuzumab emtansine) LUCENTIS® (ranibizumab injection) LUNSUMIO™ (mosunetuzumab-axgb) OCREVUS® (ocrelizumab) PERJETA® (pertuzumab) PHESGO™ (pertuzumab, trastuzumab, and hyaluronidase-zzxf) POLIVY® (polatuzumab vedotin-piiq) Pulmozyme® (dornase alfa) Inhalation Solution Rituxan® (rituximab) for Rheumatoid Arthritis (RA) RITUXAN® (rituximab) for Oncology Rituxan® (rituximab) for Granulomatosis with Polyangiitis (GPA), Microscopic Polyangiitis (MPA) or Pemphigus Vulgaris (PV) RITUXAN HYCELA® (rituximab/hyaluronidase human) ROZLYTREK® (entrectinib) SUSVIMO™ (ranibizumab injection) TECENTRIQ® (atezolizumab) VABYSMO® (faricimab-svoa) VENCLEXTA® (venetoclax tablets) XOLAIR® (omalizumab) for subcutaneous use ZELBORAF® (vemurafenib) Oncology Ophthalmology Rheumatology

Patients can submit the Patient Consent Form online using the eSubmit option. They do not have to use the mouse to create a digitally “written” signature.

MySMA Support is here for your patients. The MySMA Support team can help you understand your patient’s insurance coverage and refer your patients to appropriate financial assistance options to help them start and stay on Evrysdi.

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MySMA Support
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Coverage

Help understanding benefits and coverage, such as benefits investigations and prior authorization resources

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Reimbursement

Sample coding information and resources for denials and appeals

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Product Distribution

Information about the authorized specialty pharmacy for Evrysdi

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genentech patient support services

To learn more about your patient’s treatment, visit Evrysdi.com.

phone

For assistance, call (877) GENENTECH/(877) 436-3683
6 a.m.–5 p.m. PT, Monday through Friday

form

To enroll in MySMA Support, complete and submit the Evrysdi Start Form