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Patient Assistance Information

 
 
 
Genentech Access to Care Foundation (Kadcyla)

PO Box 2807
South San Francisco, CA 94083
Phone : (888)249-4918
Fax: (888)249-4919
Eligibility
> Insurance requirements are determined case by case, this includes Medicare PartD patients. 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 downloaded from website. Return application via fax or mail.
Required
> Diagnosis/Medical Criteria not disclosed. Doctor must complete and sign statement of medical necessity. Patient must complete Patient Authorization and Notice of Information Form.
Supply
> Amount/supply varies. Refill process and limit not specified. New application must be completed yearly.
Ship To
> Ship to Doctor's office, hospital, or pharmacy.
Note
>
 
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.
 
Kadcyla vial; single-use
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Genentech Access to Care Foundation (Kadcyla)
(Requires Acrobat Reader