What Options Are There?

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 your co-pay for your Genentech medicine, HEMLIBRA 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 HEMLIBRA Access Solutions at (877) 233-3981 for a referral.

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

Patient Access Network Foundation (PANF)

P.O. Box 221858
Charlotte, NC 28222-1858
Toll Free: 1-866-316-PANF (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 HEMLIBRA Access Solutions at (877) 233-3981 and speak with one of our Case Managers.

You’ll 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 HEMLIBRA 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 HEMLIBRA Co-pay Program

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

The HEMLIBRA 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 HEMLIBRA 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 HEMLIBRACopay.com for the full list of terms and conditions.

How to Work With HEMLIBRA Access Solutions

Step 1

Enroll in HEMLIBRA Access Solutions.

How do I enroll?

Step 2

We work with you, your doctor’s office, your health insurance plan and your specialty pharmacy or treatment center 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

What is HEMLIBRA?

HEMLIBRA is a prescription medicine used for routine prophylaxis to prevent or reduce the frequency of bleeding episodes in adults and children with hemophilia A with factor VIII inhibitors.

Important Safety Information

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

HEMLIBRA increases the potential for your blood to clot. Discontinue prophylactic use of bypassing agents the day before starting HEMLIBRA prophylaxis. Carefully follow your healthcare provider’s instructions regarding when to use an on-demand bypassing agent, and the dose and schedule you should use. HEMLIBRA may cause the following serious side effects when used with aPCC (FEIBA®), including:

  • Thrombotic microangiopathy (TMA). This is a condition involving blood clots and injury to small blood vessels that may cause harm to your kidneys, brain, and other organs. Get medical help right away if you have any of the following signs or symptoms during or after treatment with HEMLIBRA:
    • confusion
    • weakness
    • swelling of arms and legs
    • yellowing of skin and eyes
    • stomach (abdomen) or back pain
    • nausea or vomiting
    • feeling sick
    • decreased urination
  • Blood clots (thrombotic events). Blood clots may form in blood vessels in your arm, leg, lung or head. Get medical help right away if you have any of these signs or symptoms of blood clots during or after treatment with HEMLIBRA:
    • swelling in arms or legs
    • pain or redness in your arms or legs
    • shortness of breath
    • chest pain or tightness
    • fast heart rate
    • cough up blood
    • feel faint
    • headache
    • numbness in your face
    • eye pain or swelling
    • trouble seeing

If aPCC (FEIBA®) is needed, talk to your healthcare provider in case you feel you need more than 100 U/kg of aPCC (FEIBA®) total.

Before using HEMLIBRA, tell your healthcare provider about all of your medical conditions, including if you:

  • are pregnant or plan to become pregnant. It is not known if HEMLIBRA may harm your unborn baby. Females who are able to become pregnant should use birth control (contraception) during treatment with HEMLIBRA.
  • are breastfeeding or plan to breastfeed. It is not known if HEMLIBRA passes into your breast milk.

Tell your healthcare provider about all the medicines you take, including prescription medicines, over-the-counter medicines, vitamins, or herbal supplements. Keep a list of them to show your healthcare provider and pharmacist when you get a new medicine.

How should I use HEMLIBRA?

See the detailed “Instructions for Use” that comes with your HEMLIBRA for information on how to prepare and inject a dose of HEMLIBRA, and how to properly throw away (dispose of) used needles and syringes.

HEMLIBRA may interfere with laboratory tests that measure how well your blood is clotting and may cause a false reading. Talk to your healthcare provider about how this may affect your care.

What are the other possible side effects of HEMLIBRA?

The most common side effects of HEMLIBRA include: redness, tenderness, warmth, or itching at the site of injection; headache; and joint pain.

These are not all of the possible side effects of HEMLIBRA. Call your doctor for medical advice about side effects.

General information about the safe and effective use of HEMLIBRA.

Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use HEMLIBRA for a condition for which it was not prescribed. Do not give HEMLIBRA to other people, even if they have the same symptoms that you have. It may harm them. You can ask your pharmacist or healthcare provider for information about HEMLIBRA that is written for health professionals.

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 HEMLIBRA full Prescribing Information and Medication Guide for more important safety information including Serious Side Effects.