How Can We Help You?

There may be options to help you afford your Genentech medicine, no matter what type of health insurance you have.

Referrals to Independent Co-pay Assistance Foundations

If you need help with the co-pay for your Genentech medicine, Erivedge Access Solutions can refer you to an independent co-pay assistance foundation.

An independent co-pay assistance foundation is a charitable organization that gives financial assistance for medicines.

Call Erivedge Access Solutions at (888) 249-4918 for a referral.

If you would like to contact a foundation directly, you can use the information below:

Patient Access Network (PAN) Foundation
PO Box 221858 
Charlotte, NC 28222-1858
866-316-7263
www.panfoundation.org

Independent co-pay assistance foundations have their own rules for eligibility. We cannot guarantee a foundation will help you. We only can refer you to a foundation that supports your disease state. This information is provided as a resource for you. We do not endorse or show financial preference for any particular foundation. The foundations in this list are not the only ones that might be able to help you.

Referrals to the Genentech® Access to Care Foundation

The Genentech Access to Care Foundation, or GATCF, can help you receive your Genentech medicine free of charge, if you qualify.

GATCF helps people who are:

  • Uninsured—People who do not have insurance
  • Rendered uninsured—People whose health insurance does not cover their Genentech medicine
  • Underinsured—People who have health insurance (including commercial or government insurance plans), but pay more than a certain amount for their medicines each year

Other eligibility criteria must be met to qualify for free medicine from GATCF. You might qualify if you meet the requirements below.

  • Do you have health insurance?

  • Is your yearly household income less than $100,000?

  • Is your yearly household income less than $150,000?

  • Do you spend 5% or more of your yearly household income on the out-of-pocket costs for your Genentech medicine?

You Might Qualify for Free Medicine From GATCF

To apply for GATCF, you’ll need to complete the PAN form and your doctor’s office will need to complete the SMN form.

Be sure to fill out Sections 5 and 6 on the PAN form.

Download the SMN and PAN

Other Options May Be Available

You do not appear to qualify for free medicine from GATCF. However, other patient assistance options may be available to help you.

Find Out Which Option May Be Right for You

You can also call Erivedge Access Solutions at (888) 249-4918 and speak with one of our Specialists.

You have to fill out Sections 5 and 6 of the PAN form to apply for GATCF.

If you have health insurance, you must have already tried other types of patient assistance to qualify for free Genentech medicine from GATCF. This includes the Genentech BioOncology Co-pay Card and support from independent co-pay assistance foundations. You must also meet financial criteria. If you do not have insurance, you must meet different financial criteria.

Referrals to the Genentech BioOncology Co-pay Card

Erivedge Access Solutions can refer you to the Genentech BioOncology Co-pay Card. It can help you with the out-of-pocket costs for your Genentech medicine, if you’re eligible.

The Genentech BioOncology Co-pay Card helps patients with commercial health insurance. This might be a plan you get through your employer or one you purchased through a Health Insurance Marketplace like HealthCare.gov. To qualify, you must also meet other criteria.

In order to be eligible for the Genentech BioOncology Co-pay Card, the patient must have commercial insurance, must not have Medicare, Medicaid or other government insurance, and must meet other eligibility criteria. They also must agree to the rules set forth in the terms and conditions for the program. Please visit CopayAssistanceNow.com for the full list of terms and conditions.

How to Work With Erivedge Access Solutions

Step 1

Enroll in Erivedge Access Solutions.  

How do I enroll?

Step 2

We work with you, your doctor’s office, your health insurance plan and your specialty pharmacy. We might contact you for more information.

What will we find out?

Step 3

We refer you to patient assistance options.

What options are there?

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

What it Treats

Erivedge is a prescription medicine used to treat adults with a type of skin cancer, called basal cell carcinoma, that has spread to other parts of the body or that has come back after surgery or that your healthcare provider decides cannot be treated with surgery or radiation.

It is not known if Erivedge is safe and effective in children

Important Safety Information

What is the most important information I should know about Erivedge?

  • Erivedge can cause your baby to die before it is born (be stillborn) or cause your baby to have severe birth defects
  • For females who can become pregnant, talk with your healthcare provider about the risks of Erivedge to your unborn Your healthcare provider will do a pregnancy test before you start taking Erivedge. Avoid pregnancy by using birth control during treatment and for 24 months after your final dose. Tell your healthcare provider right away if you have unprotected sex or think that your birth control has failed
  • For males, Erivedge is present in semen. Do not donate semen while you are taking Erivedge and for 3 months after your final dose. You should always use a condom, even if you have had a vasectomy, during sex with female partners who are pregnant or who are able to become pregnant, during treatment with Erivedgeandfor 3monthsafteryourfinaldose to protect your female partner from being exposed to Erivedge.
  • Tell your healthcare provider right away if you or your female partner could be pregnant or thinks she is pregnant while you are taking Erivedge

Exposure to Erivedge during pregnancy:

If you become pregnant during treatment with Erivedge, you or your healthcare provider should report your pregnancy to Genentech at (888) 835-2555.

What should I tell my healthcare provider before taking Erivedge?

  • If you are pregnant or plan to become pregnant
  • If you are breastfeeding or plan to breastfeed
  • About all the medicines you take

What should I avoid while taking Erivedge?

  • Do not donate blood or blood products while you are taking Erivedge and for 24 months after your final dose
  • Do not donate semen while you are taking Erivedge and for 3 months after your final dose

What are the possible side effects of Erivedge?

  • Bone growth problems. Bone growth problems have happened in children who have been exposed to ERIVEDGE. These problems may continue even after stopping treatment with ERIVEDGE

The most common side effects of Erivedge are:

  • Muscle spasms
  • Hair loss
  • Change in how things taste or loss of taste
  • Weight loss
  • Tiredness
  • Nausea
  • Diarrhea
  • Decreased appetite
  • Constipation
  • Joint pain
  • Vomiting

Erivedge can cause absence of menstrual periods (amenorrhea) in females who are able to become pregnant. It is not known if amenorrhea is permanent. Talk to your healthcare provider if you have concerns about fertility.

These are not all of the possible side effects of Erivedge. Because everyone is different, it is not possible to predict what side effects any one person will have or how severe they may be.

Call your doctor for medical advice about side effects.

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

Please see the full Prescribing Information for additional Important Safety Information, including serious side effects, and the Medication Guide.