What Options Are There?
Whether you have insurance or not, you might feel concerned about the cost of your treatment. If you are eligible, there are options to help you pay for your ZELBORAF.*
*Each program has its own eligibility criteria.
Co-pay Assistance Foundations
We can refer you to a co-pay assistance foundation that might help pay for your Genentech medicine.
Co-pay assistance foundations are non-profit organizations that help patients with their out-of-pocket costs. The foundations listed here might be able to help you pay for your Genentech medicine.
Call ZELBORAF Access Solutions at (888) 249-4918 for a referral.
If you would like to contact a foundation directly, you can use the information below:
Metastatic Melanoma
We cannot guarantee you will get help from a co-pay assistance foundation. The co-pay assistance foundations each have their own rules, including financial rules. Genentech does not influence or control these co-pay assistance foundations. But ZELBORAF Access Solutions can help you. We can refer you to an appropriate co-pay assistance foundation.
You might qualify if you meet the requirements in the table below.
| My Health Insurance Plan | My Yearly Household Income | What I Spend on My Medicine | Could I Qualify? |
|---|---|---|---|
| I do not have a health insurance plan | $100,000 or less | — | Yes |
| $150,000 or less | I spend 5% or more of my income on the out-of-pocket costs for my medicine | Yes | |
| More than $150,000 | — | No | |
| I have a health insurance plan | $150,000 or less |
| Yes |
| More than $150,000 | — | No | |
| Whether you have health insurance or not, you must meet certain financial and medical criteria. Contact a GATCF Foundation Specialist at (866) 422-2377 for more information. | |||
To apply for this program, you must be enrolled in ZELBORAF
Access Solutions.
To enroll in ZELBORAF Access Solutions, you must complete a form called the Patient Authorization and Notice of Release of Information, or PAN. This form is located under Forms and Documents.
We also need a form from your doctor. This is called a Statement of Medical Necessity, or SMN.
If you think you might qualify for GATCF, be sure to complete Sections 5 and 6 when you fill out the PAN.
†This includes a Genentech brand co-pay card and help from a co-pay assistance foundation.
What Can I Expect?
Here is what you can expect as we work with you, your doctor and/or your health insurance plan, if you have one.
Step 2
We work with you/your doctor’s office/your health insurance plan (if you have one)
We might contact you for more information
