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Patient Assistance Information

 
1 Program for Cathflo Injection
 
 
Genentech Access to Care Foundation (TNKase, Cathflo, Activase)

1 DNA Way
Mail Stop 210
South San Francisco, CA 94080
Phone : 800-530-3083
Fax: (800)704-6615
Eligibility
> This is program is intended for uninsured patients. Medicare PartD not eligible. Gross annual household income at or below $100,000. Must be treated by US licensed healthcare provider
Who Can Apply
> Doctor/Doctor's office starts process by filling out enrollment/statement of medical necessity forms. Application can be received via fax, mail or download from website. Return application via fax or mail. Doctor will be notified of decision.
Required
> Diagnosis/Medical Criteria not disclosed. Doctor must complete and sign the application and attach a letter of medical necessity. Patient must complete Patient Authorization and Notice of Information Form available on website and attach proof of income.
Supply
> Amount supply varies. Refill process and limit varies. New application must be completed yearly.
Ship To
> Ship to Doctor's office, hospital, or pharmacy.
Note
> Please visit www.Activase.com, www.Cathflo.com & www.TNKase.com for more information.
 
Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
 
Cathflo Injection
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Genentech Access to Care Foundation (TNKase, Cathflo, Activase)
(Requires Acrobat Reader