We Are Here for You

Your treatment journey is unique. Life events, including changes in your income and insurance, may affect your financial situation.

PERJETA Access Solutions is here to help. See below for answers to frequently asked questions.

Frequently Asked Questions

About PERJETA Access Solutions

PERJETA Access Solutions is a program for people who have been prescribed PERJETA. We can help you get the PERJETA you need.

I Am Concerned About Paying for PERJETA

If you are worried about paying for PERJETA, we might be able to help. If you are eligible, there are several options to help you pay for your medicine.

Enrolling in PERJETA Access Solutions

1.     You sign and date a form called the Patient Authorization and Notice of Release of Information, or PAN form.

The PAN form lets PERJETA Access Solutions discuss your case with your doctor and your health insurance plan. You can complete the PAN form in 1 of 2 ways:

  • Fill out the PAN and submit it online
  • Print the form, sign it and give it to your doctor’s office to send to us

Remember: although this is the only form you need to complete to enroll in PERJETA Access Solutions, your doctor needs to complete another form.

To print and sign the form, visit Forms and Documents.

 

2.     Your doctor fills out a form called the Statement of Medical Necessity, or SMN.

The SMN is a form filled out and submitted by your doctor. You do not have to fill out any information on this form.

This form tells us your doctor wants to treat you with PERJETA. 

 

3.     Both forms must be submitted for you to be enrolled in PERJETA Access Solutions.

If you have signed a printed version of the PAN form, you can give it to your doctor to send with the SMN form.  If you have completed the online version of the PAN form, you can just ask your doctor if he or she has submitted the SMN to make sure you are enrolled.

The Patient Authorization and Notice of Release of Information, or PAN form, allows PERJETA Access Solutions to discuss your case with your doctor and your health insurance plan. We cannot work with you without a signed PAN form.

You do not need to do anything else, but your doctor does. He or she needs to submit a form called the Statement of Medical Necessity, or SMN. The SMN tells us your doctor wants to treat you with PERJETA. Make sure your doctor has sent us the SMN so you get help from us.

My Health Plan Denied Coverage for PERJETA

You and your doctor’s office can file an appeal to your health insurance plan. Contact your doctor to find out if filing an appeal is right for you.

We have resources to help you and your doctor file an appeal.

We have resources to help you and your doctor’s office while the appeal is prepared. Then you or your doctor’s office has to file the appeal directly with the plan.

This depends on your health insurance plan. You should ask your plan directly about its process. Sometimes the appeals process is quick. However, it can also take several months if you have to appeal several times.

My Insurance Changed

When your health insurance plan changes, be sure to tell your doctors and PERJETA Access Solutions. We can help you find out what your new health insurance plan covers and refer you to financial assistance options, if needed.

If you do not have health insurance, you might qualify for the Genentech® Access to Care Foundation, or GATCF. GATCF helps qualified patients who meet certain criteria receive PERJETA free of charge.