PHESGO Coverage
Benefits Investigations
PHESGO 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
Both the Prescriber Service Form and the Patient Consent Form must
be received before PHESGO Access Solutions can begin helping your
patient.
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
PHESGO Access Solutions can help you identify if a prior
authorization (PA) is necessary and offer resources as you obtain it
for your patient. Both the Prescriber Service Form and the Patient
Consent Form must be received before PHESGO Access Solutions can begin
helping your patient.
If your patient’s request for a PA is not granted, your Oncology Field Reimbursement Manager (FRM) or PHESGO 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.
