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 Genentech medicine?

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 Section 6 of the PAN to apply for GATCF.

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 their Genentech medicines.

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 Genentech 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 TECENTRIQ. Patients must complete Section 6 of the PAN to apply for GATCF.

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

If needed, additional GATCF-specific forms may also be requested. You can download them by selecting the button below.

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

TECENTRIQ (atezolizumab) is indicated for the treatment of patients with locally advanced or metastatic urothelial carcinoma who:

  • Are not eligible for cisplatin-containing chemotherapy, or
  • Have disease progression during or following any platinum-containing chemotherapy, or within 12 months of neoadjuvant or adjuvant chemotherapy

This indication is approved under accelerated approval based on tumor response rate and durability of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials.

TECENTRIQ is indicated for the treatment of patients with metastatic non-small cell lung cancer (NSCLC) who have disease progression during or following platinum-containing chemotherapy. Patients with EGFR or ALK genomic tumor aberrations should have disease progression on FDA-approved therapy for these aberrations prior to receiving TECENTRIQ.

Important Safety Information

Serious Adverse Reactions

Please refer to the full Prescribing Information for important dose modification information specific to adverse reactions.

  • Immune-mediated pneumonitis. Immune-mediated pneumonitis or interstitial lung disease, including fatal cases, have occurred. Permanently discontinue TECENTRIQ for Grade 3 or 4 pneumonitis
  • Immune-mediated hepatitis. Immune-mediated hepatitis and liver test abnormalities, including fatal cases, have occurred. Permanently discontinue TECENTRIQ for AST or ALT elevations more than 8 times the upper limit of normal or total bilirubin more than 3 times the upper limit of normal
  • Immune-mediated colitis. Immune-mediated colitis or diarrhea have occurred. Permanently discontinue TECENTRIQ for Grade 4 diarrhea or colitis
  • Immune-mediated endocrinopathies. Thyroid disorders, adrenal insufficiency, type 1 diabetes mellitus, including diabetic ketoacidosis, and hypophysitis/hypopituitarism have occurred
  • Other immune-mediated adverse reactions. TECENTRIQ can cause severe and fatal immune-mediated adverse reactions. These immune-mediated reactions may involve any organ system. Permanently discontinue TECENTRIQ for Grade 4 immune-mediated adverse reactions involving a major organ
  • Infections. Severe infections, including fatal cases, have occurred
  • Infusion-related reactions. Severe or life-threatening infusion-related reactions have occurred. Permanently discontinue TECENTRIQ in patients with Grade 3 or 4 infusion-related reactions
  • Embryo-fetal toxicity. TECENTRIQ can cause fetal harm in pregnant women. Verify pregnancy status prior to initiating TECENTRIQ. Advise patients of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with TECENTRIQ and for at least 5 months after the last dose
  • Advise female patients not to breastfeed while taking TECENTRIQ and for at least 5 months after the last dose

Most Common Adverse Reactions

The most common adverse reactions in cisplatin-ineligible UC (rate ≥20%) were fatigue (52%), decreased appetite (24%), diarrhea (24%), and nausea (22%).

The most common adverse reactions in previously treated UC (rate ≥20%) were fatigue (52%), decreased appetite (26%), nausea (25%), urinary tract infection (22%), pyrexia (21%), and constipation (21%).

The most common adverse reactions in NSCLC (rate ≥20%) were fatigue (43.5%), decreased appetite (23.5%), dyspnea (22%), and cough (26.4%).

You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at 1-888-835-2555.

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