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Patient Assistance Information

 
1 Program for Rituxan injection (ra, gpa & mpa)
 
 
Genentech Access to Care Foundation (Actemra, Rituxan)

1 DNA Way
Mail Stop 857A
South San Francisco, CA 94080
Phone : (866)681-3329
Fax: (866)681-3329
Eligibility
> This is program is intended for patients with no prescription coverage or have been denied coverage. Medicare PartD determined case by case. 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 received via fax, mail or download from website. Return application via fax or mail.
Required
> Diagnosis/Medical Criteria not disclosed. Doctor must complete and sign statement of medical necessity.
Supply
> Amount/Supply varies. Refill process and limit not specified. New application must be completed yearly. Patient must complete Patient Authorization and Notice of Information Form available on website, attach proof of income.
Ship To
> Ship to Doctor's office, hospital, or pharmacy.
Note
> Rituxan RA: Rheumatoid Arthritis Rituxan MPA: Microscopic Polyangilitis Rituxan GPA: Granulomatosis with Polyangilits (Formerly known as Wegener’s Granulomatosis)
 
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.
 
Rituxan injection (ra, gpa & mpa)