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Genentech Access to Care Foundation (TNKase, Cathflo, Activase)
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1 DNA Way
Mail Stop 210
South San Francisco, CA 94080
Phone
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800-530-3083
Fax:
(800)704-6615
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Eligibility
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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
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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. |
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Required
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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. |
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Supply
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Amount supply varies. Refill process and limit varies. New application must be completed yearly. |
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Ship To
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Ship to Doctor's office, hospital, or pharmacy. |
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Note
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Please visit www.Activase.com, www.Cathflo.com & www.TNKase.com for more information. |
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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.
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| Cathflo Injection |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form Genentech Access to Care Foundation (TNKase, Cathflo, Activase) |
(Requires Acrobat Reader) 
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