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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.
- ACTEMRA® (tocilizumab)
- ALECENSA® (alectinib)
- AVASTIN® (bevacizumab)
- COTELLIC® (cobimetinib)
- ERIVEDGE® (vismodegib)
- ESBRIET® (pirfenidone)
- GAZYVA® (obinutuzumab)
- HEMLIBRA® (emicizumab-kxwh)
- HERCEPTIN® (trastuzumab)
- KADCYLA® (ado-trastuzumab emtansine)
- LUCENTIS® (ranibizumab injection)
- OCREVUS® (ocrelizumab)
- PERJETA® (pertuzumab)
- PULMOZYME® (dornase alfa) Inhalation Solution
- RITUXAN® (rituximab)
- RITUXAN HYCELA™ (rituximab/hyaluronidase human)
- TARCEVA® (erlotinib)
- TECENTRIQ® (atezolizumab)
- VENCLEXTA™ (venetoclax)
- XOLAIR® (omalizumab) for subcutaneous use
- ZELBORAF® (vemurafenib)
Please select a treatment to continue
- ACTEMRA® (tocilizumab)
- ALECENSA® (alectinib)
- AVASTIN® (bevacizumab)
- COTELLIC® (cobimetinib)
- ERIVEDGE® (vismodegib)
- ESBRIET® (pirfenidone)
- GAZYVA® (obinutuzumab)
- HEMLIBRA® (emicizumab-kxwh)
- HERCEPTIN® (trastuzumab)
- KADCYLA® (ado-trastuzumab emtansine)
- LUCENTIS® (ranibizumab injection)
- OCREVUS® (ocrelizumab)
- PERJETA® (pertuzumab)
- PULMOZYME® (dornase alfa) Inhalation Solution
- RITUXAN® (rituximab)
- RITUXAN HYCELA™ (rituximab/hyaluronidase human)
- TARCEVA® (erlotinib)
- TECENTRIQ® (atezolizumab)
- VENCLEXTA™ (venetoclax)
- XOLAIR® (omalizumab) for subcutaneous use
- ZELBORAF® (vemurafenib)
Or Select
- BIOONCOLOGY
- RHEUMATOLOGY
Please select a treatment to continue
Select a disease state for Rituxan® (rituximab)