Referrals to Independent Co-pay Assistance Foundations
An independent co-pay assistance foundation is a charitable
organization providing financial assistance to patients with specific
disease states. GAZYVA Access Solutions offers referrals to
independent co-pay assistance foundations for eligible patients who
are commercially or publicly insured, including those covered by
Medicare and Medicaid.
Listing of Independent Co-pay Assistance Foundations
Select from the available disease states below for a list of
foundations. This information is updated regularly.
Chronic Lymphocytic Leukemia
Relapsed/Refractory Follicular Lymphoma
Genentech does not influence or control the operations or
eligibility criteria of any independent co-pay assistance foundation
and cannot guarantee co-pay assistance after a referral from GAZYVA
Access Solutions. This information is provided as a resource to
patients. Please note that this list is not indicative of
Genentech's endorsement or financial support of any particular
disease area and/or foundation, nor is it exhaustive. There may be
other foundations to support the patient’s disease state.
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.