Genentech® Access to Care Foundation (GATCF)

GATCF helps eligible patients who meet specific medical and financial criteria receive Genentech medicines free of charge. 

Is My Patient Eligible?

Insurance Financial Medical

Patient is without coverage for Genentech medicine

(uninsured or rendered uninsured by payer denial)

Patient annual household AGI is

≤$100,000

OR

Patient annual household AGI is

>$100,000–≤$150,000

and the out-of-pocket costs for his/her Genentech medicines account for ≥5% of his/her annual household AGI

Patient must be prescribed a Genentech medicine and meet certain medical criteria as established by an independent advisory board

Patient has coverage for Genentech medicine

(insured)

Patient annual household AGI is

≤$150,000

and the out-of-pocket costs for his/her Genentech medicines account for ≥5% of his/her annual household AGI

AND

All patient assistance options have been exhausted, including Genentech brand-specific co-pay cards and support from co-pay assistance foundations supporting the patient’s disease state

AGI=adjusted gross income.

Download this PDF file to view more information on eligibility criteria.

How Do I Get My Patient Started?

Complete and submit enrollment forms and submit them to XOLAIR Access Solutions:

  • Statement of Medical Necessity (SMN)
  • Patient Authorization and Notice of Release of Information (PAN)

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

When completing the SMN, be sure to complete all sections of the form.

OR

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

Once we receive your patient’s information, XOLAIR Access Solutions will contact the patient within 24 hours with further instructions. This might include verifying financial eligibility.