What Options Are There?
Whether you have insurance or not, you might feel concerned about the cost of your treatment. If you are eligible, there are options to help you pay for your Erivedge.*
*Each program has its own eligibility criteria.
We can refer you to an independent co-pay assistance foundation that might help pay for your Genentech medicine.
Independent co-pay assistance foundations are non-profit organizations that help patients with their out-of-pocket costs. The foundations listed here might be able to help you pay for your Genentech medicine.
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:
Advanced Basal Cell Carcinoma
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.
You might qualify if you meet the requirements below.
To apply for this program, you must be enrolled in Erivedge Access Solutions.
To enroll in Erivedge Access Solutions, you must complete a form called the Patient Authorization and Notice of Release of Information, or PAN. This form is located under Forms and Documents.
We also need a form from your doctor. This is called a Statement of Medical Necessity, or SMN.
If you think you might qualify for GATCF, be sure to complete Sections 5 and 6 when you fill out the PAN.
†Including Genentech brand-specific co-pay cards and support from independent co-pay assistance foundations.
In order to be eligible for The Genentech BioOncology Co-pay Card, you must confirm that you meet the eligibility criteria and agree to the rules set forth in the terms and conditions for the program. Please visit www.CopayAssistanceNow.com for the full list of terms and conditions.
What Can I Expect?
Here is what you can expect as we work with you, your doctor and/or your health insurance plan, if you have one.