POLIVY Access Solutions
We are dedicated to helping you understand your insurance coverage
and assistance options. This can help you get the Genentech medicine
your doctor prescribed.
Ready to Enroll?
Fill out the Patient Consent Form and
send it to POLIVY Access Solutions to get started. The form can be
submitted in any of these 3 ways:
Text a photo
Take a photo of your signed form and text it to POLIVY Access Solutions
Fill out and submit the form online
Download and fax
Fax your completed and signed form to POLIVY Access Solutions