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:

Download and fax

Fax your completed and signed form to POLIVY Access Solutions

Submit online

Fill out and submit the form online

Text a photo

Take a photo of your signed form and text it to POLIVY Access Solutions