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ACTEMRA Coverage

Benefits Investigations

ACTEMRA Access Solutions can conduct a benefits investigation (BI) to help you determine if a Genentech medicine is covered, if prior authorizations (PAs) are required, which specialty pharmacy (SP) the health insurance plan prefers and if financial assistance might be needed.

Potential outcomes of a BI:

  • Treatment is covered
  • PA is required
  • Treatment is denied

Both the Prescriber Service Form and the Patient Consent Form must be received before ACTEMRA Access Solutions can begin helping your patient.

These can be downloaded from Forms and Documents or submitted online via My Patient Solutions.

The completion and submission of coverage- or reimbursement-related documentation are the responsibility of the patient and health care provider. Genentech makes no representation or guarantee concerning coverage or reimbursement for any service or item.

Prior Authorization

ACTEMRA Access Solutions can help you identify if a prior authorization (PA) is necessary and offer resources as you request it for your patient. Both the Prescriber Service Form and the Patient Consent Form must be received before ACTEMRA Access Solutions can begin helping your patient.

If your patient’s request for a PA is not granted, your Field Reimbursement Manager (FRM) or ACTEMRA Access Solutions Specialist can work with you to determine your next steps. You can find more tips like this in Forms and Documents.

The completion and submission of coverage- or reimbursement-related documentation are the responsibility of the patient and health care provider. Genentech makes no representation or guarantee concerning coverage or reimbursement for any service or item.

RSVP for ACTEMRA for Intravenous (IV) Infusion

When a medical treatment is authorized for a limited period of time, it will generally require reverification for coverage of continued treatment. ACTEMRA Access Solutions can help you obtain reverification for your patients.

You have the opportunity to request an annual reverification of benefits through our My Patients Solutions portal. My Patient Solutions is an online tool to help you enroll your patients in Genentech Access Solutions where we can assist you in doing benefit investigations and re-verifying benefits for your patients on ACTEMRA.

You can download the enrollment form from Forms and Documents.

phone

For assistance, call (877) GENENTECH/(877) 436-3683
6 a.m.–5 p.m. PT, Monday through Friday