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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

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, regardless of treatment. POLIVY 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

These organizations may be able to help your patients. Please check their websites for up-to-date information on the assistance they provide.

CancerCare Co-Payment Assistance Foundation

Patient Access Network Foundation (PANF)

The HealthWell Foundation

The Leukemia and Lymphoma Society

Independent co-pay assistance foundations have their own rules for eligibility. Genentech has no involvement or influence in independent foundation decision-making or eligibility criteria and does not know if a foundation will be able to help your patient. We can only refer your patient to a foundation that supports their disease state. This information is provided as a resource for you. Genentech does not endorse or show preference for any particular foundation. The foundations in this list may not be the only ones that might be able to help your patient.

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

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