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 XOLAIR?
Your Patient Appears to Be Eligible for GATCF
To get started with GATCF, complete and submit the SMN and PAN to XOLAIR Access Solutions. Patients must complete Section 6 of the PAN to apply for GATCF.
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 XOLAIR.
Call XOLAIR Access Solutions at (800) 704-6610 or use our Patient Assistance Tool to find out which option may be right for your patient.
To be eligible for free medicine from GATCF, insured patients must
have exhausted all other forms of patient assistance (including the
XOLAIR Co-pay Card Program 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 XOLAIR Access Solutions. Patients must complete Section 6 of the PAN to apply for GATCF.
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, XOLAIR Access Solutions will contact the patient with further instructions. This might 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.