Find Patient Assistance

Answer a few simple questions to find out which patient assistance option might be right for your patient.

  • Is your patient insured?

  • Does the patient's insurance cover his or her Genentech medicine?

  • Does your patient have commercial insurance?

    What does this mean?
  • Has your patient already been referred to the Genentech BioOncology Co-pay Card and is either ineligible or no longer receiving assistance?

  • Has your patient already been referred to an independent co-pay assistance foundation and is either ineligible or no longer receiving assistance?

  • Is the patient 18 years of age or older?

Your Patient Might Qualify for a Referral to the Genentech BioOncology Co-pay Assistance Program

If eligible commercially insured patients need assistance with their out-of-pocket costs, POLIVY Access Solutions can refer them to the Genentech BioOncology Co-pay Assistance Program.*

 

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*This Genentech BioOncology Co-pay Assistance Program is valid ONLY for patients with commercial insurance who have a valid prescription for a Food and Drug Administration (FDA)-approved indication of a Genentech medication. Patients using Medicare, Medicaid, or any other federal or state government program to pay for their medications are not eligible.

Under the Program, the patient will pay a co-pay. After reaching the maximum Program benefit, the patient will be responsible for all out-of-pocket costs.

All participants are responsible for reporting the receipt of all Program benefits as required by any insurer or by law. No party may seek reimbursement for all or any part of the benefit received through this Program. This Program is void where prohibited by law. Genentech reserves the right to rescind, revoke, or amend the Program without notice at any time. Additional eligibility criteria apply. See full terms and conditions at CopayAssistanceNow.com.

Your Patient Might Qualify for a Referral to an Independent Co-pay Assistance Foundation

For eligible patients with commercial or public health insurance, POLIVY Access Solutions offers referrals to independent co-pay assistance foundations.*

 

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*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 POLIVY Access Solutions. The foundations to which we refer patients are not exhaustive or indicative of Genentech’s endorsement or financial support. There may be other foundations to support the patient's disease state.

Your Patient Might Qualify for a Referral to the Genentech Patient Foundation

The Genentech Patient Foundation provides free Genentech medicine to people who don't have insurance coverage or who have financial concerns and to people who meet certain income criteria.*

 

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*To be eligible for free Genentech medicine from the Genentech Patient Foundation, insured patients who have coverage for their medicine must have exhausted all other forms of patient assistance (including the Genentech BioOncology Co-pay Assistance Program and support from independent co-pay assistance foundations) and must meet financial criteria. Uninsured patients and insured patients without coverage for their medicine must meet different financial criteria.

Patient Assistance Options

Referrals to the Genentech BioOncology Co-pay Assistance Program

POLIVY Access Solutions can refer eligible patients to the Genentech BioOncology Co-pay Assistance Program for help with the out-of-pocket costs associated with their Genentech medicine.*

Learn More

Referrals to Independent Co-pay Assistance Foundations

For eligible patients with commercial or public health insurance, POLIVY Access Solutions offers referrals to independent co-pay assistance foundations.†

Learn More

Referrals to the Genentech Patient Foundation

The Genentech Patient Foundation provides free Genentech medicine to people who don't have insurance coverage or who have financial concerns and to people who meet certain income criteria.‡

Learn More

*This Genentech BioOncology Co-pay Assistance Program is valid ONLY for patients with commercial insurance who have a valid prescription for a Food and Drug Administration (FDA)-approved indication of a Genentech medication. Patients using Medicare, Medicaid, or any other federal or state government program to pay for their medications are not eligible.

Under the Program, the patient will pay a co-pay. After reaching the maximum Program benefit, the patient will be responsible for all out-of-pocket costs.

All participants are responsible for reporting the receipt of all Program benefits as required by any insurer or by law. No party may seek reimbursement for all or any part of the benefit received through this Program. This Program is void where prohibited by law. Genentech reserves the right to rescind, revoke, or amend the Program without notice at any time. Additional eligibility criteria apply. See full terms and conditions at CopayAssistanceNow.com.

†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 POLIVY Access Solutions. The foundations to which we refer patients are not exhaustive or indicative of Genentech’s endorsement or financial support. There may be other foundations to support the patient's disease state.

‡To be eligible for free Genentech medicine from the Genentech Patient Foundation, insured patients who have coverage for their medicine must have exhausted all other forms of patient assistance (including the Genentech BioOncology Co-pay Assistance Program and support from independent co-pay assistance foundations) and must meet financial criteria. Uninsured patients and insured patients without coverage for their medicine must meet different financial criteria.

Important Safety Information & Indication

Indication Statement

POLIVY in combination with bendamustine and a rituximab product is indicated for the treatment of adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL), not otherwise specified, after at least 2 prior therapies.

Accelerated approval was granted for this indication based on complete response rate. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial.

Warnings and Precautions
Peripheral Neuropathy: Monitor patients for peripheral neuropathy and modify or discontinue dose accordingly.
Infusion-Related Reactions: Premedicate with an antihistamine and an antipyretic. Monitor patients closely during infusions. Interrupt or discontinue infusion if reactions occur.
Myelosuppression: Monitor complete blood counts. Manage using dose delays or reductions and growth factor support. Monitor for signs of infection.
Serious and Opportunistic Infections: Closely monitor patients for signs of bacterial, fungal, or viral infections.
Progressive Multifocal Leukoencephalopathy (PML): Monitor patients for new or worsening neurological, cognitive, or behavioral changes suggestive of PML.
Tumor Lysis Syndrome: Closely monitor patients with high tumor burden or rapidly proliferating tumors.
Hepatotoxicity: Monitor liver enzymes and bilirubin.
Embryo-Fetal Toxicity: Can cause fetal harm. Advise females of reproductive potential of the potential risk to a fetus and to use effective contraception during treatment and for 3 months after the last dose.

The Most Common Adverse Reactions
The most common adverse reactions (≥20%) included neutropenia, thrombocytopenia, anemia, peripheral neuropathy, fatigue, diarrhea, nausea, pyrexia, decreased appetite, abdominal pain, and pneumonia.

You may report side effects to the FDA at (800) FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at (888) 835-2555.

Please see the full Prescribing Information for additional Important Safety Information.