Referrals to the Genentech® Access to Care Foundation (GATCF)

GATCF provides free medicine to eligible patients who are uninsured, rendered uninsured by payer denial or underinsured. To qualify, patients must meet financial criteria.

Is My Patient Eligible?

  • Does your patient have health insurance?

  • Is your patient’s annual household adjusted gross income (AGI) less than $100,000?

  • Is your patient’s annual household adjusted gross income (AGI) less than $150,000?

  • Does your patient spend 5% or more of his or her annual household AGI on the out-of-pocket costs for his or her RITUXAN HYCELA?

Your Patient Appears to Be Eligible for GATCF

To get started with GATCF, complete and submit the SMN and PAN to Genentech BioOncology® Access Solutions. Patients must complete Sections 5 and 6 of the PAN to apply for GATCF.

Click here to go to the Forms and Documents page to download the SMN and PAN forms.

Download the Forms

Your Patient Does Not Appear to Be Eligible for GATCF, but Other Options May Be Available

Several options are available to help eligible patients with the out-of-pocket costs of RITUXAN HYCELA.

Call Genentech BioOncology® Access Solutions at (888) 249-4918 or use our Patient Assistance Tool to find out which option may be right for your patient.

Use the Patient Assistance Tool

To be eligible for free medicine from GATCF, insured patients must have exhausted all other forms of patient assistance (including the Genentech BioOncology Co-pay Card and support from independent co-pay assistance foundations) and meet financial criteria. Uninsured patients must meet different financial criteria.

Download this flash card to view a summary of GATCF eligibility and enrollment information.

How Do I Get My Patient Started?

To apply for GATCF, submit the completed SMN and PAN to Genentech BioOncology® Access Solutions for RITUXAN HYCELA. Patients must complete Sections 5 and 6 of the PAN to apply for GATCF.

These forms can be submitted online via My Patient Solutions or downloaded from Forms and Documents.

Only the information requested on these forms is required. Providing additional documents or information will delay processing.

Once we receive your patient’s information, Genentech BioOncology Access Solutions will contact the patient with further instructions. This may include verifying financial eligibility.

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.

Important Safety Information & Indication

Indication

RITUXAN HYCELA® (rituximab/hyaluronidase human) is indicated for the treatment of adult patients with:

  • Relapsed or refractory, follicular lymphoma (FL) as a single agent.
  • Previously untreated follicular lymphoma in combination with first-line chemotherapy and, in patients achieving a complete or partial response to rituximab in combination with chemotherapy, as single-agent maintenance therapy.
  • Non-progressing (including stable disease) follicular lymphoma as a single agent after first-line cyclophosphamide, vincristine, and prednisone (CVP) chemotherapy.
  • Previously untreated diffuse large B-cell lymphoma (DLBCL) in combination with cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) or other anthracycline based-chemotherapy regimens.
  • Previously untreated and previously treated chronic lymphocytic leukemia (CLL) in combination with fludarabine and cyclophosphamide (FC).

Initiate treatment with RITUXAN HYCELA only after patients have received at least one full dose of RITUXAN®

RITUXAN HYCELA is not indicated for the treatment of non-malignant conditions.

Important Safety Information

BOXED WARNINGS: SEVERE MUCOCUTANEOUS REACTIONS, HEPATITIS B VIRUS REACTIVATION and PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY

  • Severe Mucocutaneous Reactions: Severe, including fatal, mucocutaneous reactions can occur in patients receiving rituximab-containing products, including RITUXAN HYCELA.
  • Hepatitis B Virus (HBV) Reactivation: HBV reactivation can occur in patients treated with rituximab-containing products, including RITUXAN HYCELA, in some cases resulting in fulminant hepatitis, hepatic failure, and Screen all patients for HBV infection before treatment initiation, and monitor patients during and after treatment with RITUXAN HYCELA. Discontinue RITUXAN HYCELA and concomitant medications in the event of HBV reactivation.
  • Progressive Multifocal Leukoencephalopathy (PML), including fatal PML, can occur in patients receiving rituximab-containing products, including RITUXAN HYCELA.

Warnings and Precautions

Hypersensitivity and Other Administration Reactions

  • Local cutaneous reactions may occur more than 24 hours after administration. Interrupt injection if severe reaction develops. Premedicate before injection

Tumor Lysis Syndrome (TLS)

  • TLS can occur within 12-24 hours after administration of a rituximab-containing product, including RITUXAN HYCELA. Administer aggressive intravenous hydration, anti-hyperuricemic agents, monitor renal function

Infections

  • Severe, including fatal, bacterial, fungal, and new or reactivated viral infections can occur during and following the completion of therapy with rituximab-containing products, including RITUXAN HYCELA. Withhold and institute appropriate anti-infective therapy.

Cardiovascular Adverse Reactions

  • Discontinue in case of serious or life-threatening events

Renal Toxicity

  • Severe, including fatal, renal toxicity can occur after administration of rituximab-containing products, including RITUXAN HYCELA. Discontinue in patients with rising serum creatinine or oliguria

Bowel Obstruction and Perforation

  • Abdominal pain, bowel obstruction, and perforation, in some cases leading to death, can occur in patients receiving rituximab-containing products, including RITUXAN HYCELA, in combination with chemotherapy. Consider and evaluate for abdominal pain, vomiting, or related symptoms

Immunization

  • Live virus vaccinations prior to or during treatment not recommended

Embryo-Fetal Toxicity

  • Can cause neonatal harm. Advise of potential risk to neonates and use of effective contraception.

Adverse Reactions

  • The most common adverse reactions (≥ 20%) of RITUXAN HYCELA observed in patients with FL in SABRINA were: infections, neutropenia, nausea, constipation, cough, and fatigue.
  • The most common adverse reactions (≥ 20%) of RITUXAN HYCELA observed in patients with DLBCL in MabEASE were: infections, neutropenia, alopecia, nausea, and anemia.
  • The most common adverse reactions (≥ 20%) of RITUXAN HYCELA observed in patients with CLL in part 2 of SAWYER were: infections, neutropenia, nausea, thrombocytopenia, pyrexia, vomiting, and injection site erythema.

Please see the full Prescribing Information, including BOXED WARNINGS and Medication Guide, for additional Important Safety Information.

Attention Healthcare Provider: Provide Medication Guide to patient prior to RITUXAN HYCELA treatment.

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.