Skip To Main Content

Submit the Patient Consent Form online using eSubmit. You do not have to create a signature with your finger or the mouse to sign the form.

MySMA Support is a support service from Genentech that can help provide information about Evrysdi.

Call us at (833) 387-9734.

Learn More

How Can MySMA Support Help?

product education

Product education

  • Information about the effectiveness and Important Safety Information of Evrysdi
  • Guidance on administering Evrysdi
insurance and financial assistance

Insurance and financial assistance*

  • Insurance benefits investigation
  • Resources to help the health care provider's office with prior authorizations and appeals
  • Financial assistance for eligible individuals, including co-pay and free drug programs
additional support

Additional support

  • Coordination with the specialty pharmacy for preparation and delivery of Evrysdi
  • Disease- and treatment-related educational material

*You and your doctor are responsible for completing and submitting all required paperwork to your health insurance plan. Genentech cannot guarantee your plan will cover any treatments.