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 Esbriet.*
*Each program has its own eligibility criteria.
Co-pay Assistance Foundations
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 Esbriet Access Solutions at (844) 372-7438 for a referral.
If you would like to contact a foundation directly, you can use the information below:
Idiopathic Pulmonary Fibrosis
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.
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Do you have health insurance?
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Is your yearly household income less than $100,000?
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Is your yearly household income less than $150,000?
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Do you spend 5% or more of the yearly household income on the out-of-pocket costs for your Genentech medicine?
You Might Qualify for Free Medicine From GATCF
To apply, you must enroll in Esbriet Access Solutions. To do this, you must sign a form called the Patient Authorization and Notice of Release of Information, or PAN.
Be sure to fill out Section 6 of the PAN to apply for help from GATCF.
Your doctor also has to fill out a form. Once we receive both forms, we can find out if you qualify.
Click here to go to the Forms and Documents page to download the SMN and PAN forms.
Other Options May Be Available
You do not appear to qualify for free medicine from GATCF. However, there may be other patient assistance options that might be able to help you.
The Patient Assistance Tool can help you find out which option may be right for you.
Use the Patient Assistance Tool
You can also call Esbriet Access Solutions at (844) 372-7438 and speak with one of our Specialists.
To apply for this program, you must be enrolled in Esbriet Access Solutions.
If you have health insurance, you must have already tried other types of patient assistance to qualify for free medicine from GATCF. This includes Genentech co-pay cards and support from co-pay assistance foundations. You must also meet specific criteria.
In order to be eligible for The Esbriet 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.EsbrietCopay.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.
Step 2
We work with you/your doctor’s office/your health insurance plan (if you have one)
We might contact you for more information
