You can download the registration form under Forms and Documents. For printed copies you can give your patients and information about other resources, please contact your Genentech Field Reimbursement Manager or visit GenentechPatientFoundation.com. ACTEMRA Access Solutions may conduct an employee benefits (IB) investigation to determine whether a Genentech drug is covered, whether prior authorization (PA) is required, which specialty pharmacy (SP) the health insurance company prefers, and whether patient assistance may be required. Submit Genentech Ophthalmological Access Solutions forms and check the status of your service requests online with My Patient Solutions Each year, you will receive a list of ACTEMRA patients you have referred to ACTEMRA Access Solutions. You must review and select the patients for whom you would like to obtain a performance evaluation (BI) and return the list to us. If you do not wish to use this service, you can unsubscribe by checking the box on the registration form or by calling us directly. Both forms are required. We must have both the patient consent form and the prescription service form before we can help you. Genentech Benefit Studies Ophthalmology Access Solutions may conduct an Benefits Survey (BI) that may determine: Your patient must complete the patient consent form. You can download the patient consent form as part of your application or ask your patient to submit the form by fax, text message or email.
Genentech Ophthalmology Access Solutions provides a range of access and reimbursement resources for your PATIENTS AND YOUR LUCENTIS post-prescription practice, including help with performance surveys (BI), pre-approval (PA) resources, billing and coding information examples, rejection and call resources, distribution information, and references to potential financial support options. This coding information can help you fill out payment forms for LUCENTIS. These tables are provided for informational purposes only. Please check the websites CMS.gov or other payers for additional guidance on their billing and coding processes. While a performance review is not required to receive support, the Genentech Patient Foundation may use performance reviews as an internal tool to support a claim decision. We require health care providers to be aware of the patient`s coverage status and confirm it before registering with the foundation. Visit the Find out how to get our medicines page to find out which Genentech medicines are eligible for replacement. We encourage all patients to consider other forms of financial assistance before applying for support from the Genentech Patient Foundation. These may be Genentech co-payment programs and/or independent co-payment foundations. No. You can always ask the Genentech Patient Foundation for help while you and your doctor appeal.
You do not need to send us proof of your call for help. Genentech Access Solutions may be able to explain the policy of the insurance plan If your patient`s health insurance has issued a refusal, your Genentech Ophthalmology Access Solutions Specialist can provide you with resources while you prepare a call submission according to the requirements of your patient plan. If your insurance does not cover your medication, it may be because: Resellers for state-qualified medical practices and health centers Although it is preferable that the prescriber`s basic form and the patient`s consent form be sent together, we can still verify the patient`s eligibility if we receive them separately. Through the ACT Fast program, eligible patients taking ACTEMRA can receive free medications while their insurance coverage is determined. How much you and your household members earn each year minus the specific deductions. This is also often referred to as your adjusted gross income, or AGI. If you have any questions, please call a Foundation Specialist at (888) 941-3331 Monday to Friday from 6 a.m. to 5 p.m.
PT. The prescriber service form and patient consent form must be received before ACTEMRA access solutions can assist your patient. If you believe your patient is eligible for the ACT Fast program, send the completed Prescriber Service Form and Patient Consent Form to ACTEMRA Access Solutions.