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, Esbriet 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 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:

The HealthWell Foundation
P.O. Box 220410
Chantilly, VA 20153-0410
Toll Free: 1-800-675-8416
www.healthwellfoundation.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 Esbriet Access Solutions at (844) 372-7438 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 Esbriet Co-pay Program 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 Esbriet Co-pay Program

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

The Esbriet Co-pay Program 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 Esbriet Co-pay Program, 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 EsbrietCopay.com for the full list of terms and conditions.

How to Work With Esbriet Access Solutions

Step 1

Enroll in Esbriet 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

Esbriet is a prescription medicine used to treat people with a lung disease called idiopathic pulmonary fibrosis (IPF).

It is not known if Esbriet is safe and effective in children.

Select Important Safety Information

Before you take Esbriet, tell your doctor about all of your medical conditions, including if you:

  • have liver problems.
  • have kidney problems.
  • are a smoker.
  • are pregnant or plan to become pregnant. It is not known if Esbriet will harm your unborn baby.
  • are breastfeeding or plan to breastfeed. It is not known if Esbriet passes into your breast milk.

You and your doctor should decide if you will take Esbriet or breastfeed.

Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

What should I avoid while taking Esbriet?

  • Sunlight. Esbriet can make your skin sensitive to the sun and the light from sunlamps and tanning beds. You could get a severe sunburn. Use sunscreen (SPF 50) and wear a hat and clothes that cover your skin if you have to be in sunlight. Talk to your doctor if you get sunburn or a rash.
  • Taking Esbriet with other medicines that can make your skin sensitive to the sun, the light from sunlamps and tanning beds.
  • Smoking. Smoking may affect how well Esbriet works.

What are the possible side effects of Esbriet?

Esbriet may cause serious side effects, including:

  • liver problems. Call your doctor right away if you have unexplained symptoms such as yellowing of your skin or the white part of your eyes (jaundice), dark or brown (tea-colored) urine, pain on the upper right side of your stomach area (abdomen), bleeding or bruising more easily than normal, or feeling tired. Your doctor will do blood tests to check how your liver is working during your treatment with Esbriet.
  • sensitivity to sunlight (photosensitivity) and rash. See “What should I avoid while taking Esbriet?”
  • stomach problems. Esbriet may cause stomach problems such as nausea, vomiting, diarrhea, indigestion, heartburn, and stomach pain. Tell your doctor right away if your stomach problems get worse or do not go away. Your doctor may need to change your dose of Esbriet.

The most common side effects of Esbriet include feeling tired, insomnia, upper respiratory tract infections, sinusitis, headache, dizziness, decreased weight and decreased or loss of appetite.

These are not all the possible side effects of Esbriet.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at 1-888-835-2555.

Please see full Prescribing Information, including Patient Information, for additional important safety information at esbriet.com.