Genentech Rheumatology Access Solutions^©: Connecting Your Patients to Rituxan

Genentech Rheumatology Access Solutions is committed to helping all patients access our medicines, regardless of their ability to pay. Our dedicated staff of Specialists can:

• Resolve benefits and coverage issues
• Find co-pay assistance for underinsured patients
• Help uninsured patients apply for free medicine through the Genentech^© Access to Care Foundation

Use the links below for quick access to services individualized to meet your patients' specific needs.

Patient Assistance

Referrals for co-pay assistance*
For privately or publicly insured patients

Genentech^© Access to Care Foundation
For uninsured patients or those rendered uninsured by payer denial

RITUXAN EXPERIENCE Program^†
For privately insured patients

All patient assistance programs

Enrollment Forms and Other Documents

Statement of Medical Necessity Form (SMN)*
A form with basic patient, insurance, and prescription information used when contacting a patient's health care plan to determine his or her reimbursement coverage

Patient Authorization and Notice of Release of Information form (PAN)
A form signed and dated by your patient giving written permission for Genentech Rheumatology Access Solutions to discuss his or her case with you and the patient's health care plan

Sample appeal letter
A template to use when appealing a denial of Rituxan on behalf of your patient

All forms and documents

Additional Resources

Coverage and reimbursement
From benefits investigation to guidance with denials and appeals, Genentech Rheumatology Access Solutions helps your office resolve coverage and reimbursement-related needs

List of authorized distributors

*If privately or publicly insured patients have difficulty paying for their Rituxan co-pay, co-insurance or other expenses, Genentech Rheumatology Access Solutions can refer them to an independent, non-profit organization (INO) supporting their disease state. Genentech does not influence or control the operations of these INOs, but Genentech Rheumatology Access Solutions can assist patients in navigating the process of seeking co-pay assistance by making an appropriate referral based on a patient's diagnosis and by assisting with the application process. We cannot guarantee co-pay assistance once a patient has been referred by Genentech Rheumatology Access Solutions. The INOs to which we refer patients each have their own criteria for patient eligibility, including financial eligibility.

^†The RITUXAN EXPERIENCE Program is not a benefit plan. This program helps with the co-pay for the Rituxan drug only. It does not pay for other costs related to the visit or infusion. Genentech reserves the right to change or end this program. This may be done in whole or in part, without notice, at any time.