Tarceva Coverage

Benefits Investigations

Tarceva Access Solutions can conduct a benefits investigation (BI) to help you determine if Tarceva 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

A BI may be initiated once the SMN and PAN are submitted to Tarceva Access Solutions.

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 and Astellas Pharma US make no representation or guarantee concerning coverage or reimbursement for any service or item.

Prior Authorization

Tarceva Access Solutions can help you identify if a prior authorization (PA) is necessary and offer resources as you obtain it for your patient. PA support may be provided once the SMN and PAN are submitted to Tarceva Access Solutions.

If your patient’s request for a PA is not granted, your BioOncology Field Reimbursement Manager (BFRM) or Tarceva 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 and Astellas Pharma US make no representation or guarantee concerning coverage or reimbursement for any service or item.

SureStart® Program

With the SureStart Program, eligible patients taking Tarceva may receive free medicine while awaiting an insurance coverage determination.

If you think your patient qualifies for the SureStart Program, submit the completed SMN and PAN to Tarceva Access Solutions.

Eligible patients can receive a 15-day shipment of Tarceva for up to 3 months. Once coverage has been determined, the patient no longer qualifies for the SureStart Program.

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.