ZELBORAF Access Solutions can conduct a benefits investigation
(BI) to help you determine if a Genentech medicine is covered, if
prior authorizations (PAs) are required, which specialty pharmacy (SP)
the health insurance plan prefers and if patient assistance might be
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 ZELBORAF
ZELBORAF 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 ZELBORAF Access Solutions.
If your patient’s request for a PA is not granted, your BioOncology Field Reimbursement Manager (BFRM) or ZELBORAF 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 makes no representation or guarantee concerning
coverage or reimbursement for any service or item.
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.