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ACTEMRA® (tocilizumab)‎ ALECENSA® (alectinib) Avastin® (bevacizumab) COLUMVI™ (glofitamab-gxbm) COTELLIC® (cobimetinib) ENSPRYNG™ (satralizumab-mwge) Erivedge® (vismodegib) Evrysdi® (risdiplam) GAZYVA® (obinutuzumab) HEMLIBRA® (emicizumab-kxwh) Herceptin® (trastuzumab) Herceptin HYLECTA™ (trastuzumab and hyaluronidase-oysk) Itovebi™ (inavolisib) KADCYLA® (ado-trastuzumab emtansine) LUCENTIS® (ranibizumab injection) LUNSUMIO™ (mosunetuzumab-axgb) OCREVUS® (ocrelizumab) and OCREVUS ZUNOVO™ (ocrelizumab & hyaluronidase-ocsq) PERJETA® (pertuzumab) PHESGO™ (pertuzumab, trastuzumab, and hyaluronidase-zzxf) PiaSky™ (crovalimab-akkz) POLIVY® (polatuzumab vedotin-piiq) Pulmozyme® (dornase alfa) Inhalation Solution Rituxan® (rituximab) for Rheumatoid Arthritis (RA) RITUXAN® (rituximab) for Oncology Rituxan® (rituximab) for Granulomatosis with Polyangiitis (GPA), Microscopic Polyangiitis (MPA) or Pemphigus Vulgaris (PV) RITUXAN HYCELA® (rituximab/hyaluronidase human) ROZLYTREK® (entrectinib) SUSVIMO™ (ranibizumab injection) TECENTRIQ® (atezolizumab) TECENTRIQ HYBREZA™ (atezolizumab and hyaluronidase-tqjs) VABYSMO® (faricimab-svoa) VENCLEXTA® (venetoclax tablets) XOLAIR® (omalizumab) for subcutaneous use ZELBORAF® (vemurafenib) Oncology Ophthalmology Rheumatology

ACTEMRA® (tocilizumab)‎ ALECENSA® (alectinib) Avastin® (bevacizumab) COLUMVI™ (glofitamab-gxbm) COTELLIC® (cobimetinib) ENSPRYNG™ (satralizumab-mwge) Erivedge® (vismodegib) Evrysdi® (risdiplam) GAZYVA® (obinutuzumab) HEMLIBRA® (emicizumab-kxwh) Herceptin® (trastuzumab) Herceptin HYLECTA™ (trastuzumab and hyaluronidase-oysk) Itovebi™ (inavolisib) KADCYLA® (ado-trastuzumab emtansine) LUCENTIS® (ranibizumab injection) LUNSUMIO™ (mosunetuzumab-axgb) OCREVUS® (ocrelizumab) and OCREVUS ZUNOVO™ (ocrelizumab & hyaluronidase-ocsq) PERJETA® (pertuzumab) PHESGO™ (pertuzumab, trastuzumab, and hyaluronidase-zzxf) PiaSky™ (crovalimab-akkz) POLIVY® (polatuzumab vedotin-piiq) Pulmozyme® (dornase alfa) Inhalation Solution Rituxan® (rituximab) for Rheumatoid Arthritis (RA) RITUXAN® (rituximab) for Oncology Rituxan® (rituximab) for Granulomatosis with Polyangiitis (GPA), Microscopic Polyangiitis (MPA) or Pemphigus Vulgaris (PV) RITUXAN HYCELA® (rituximab/hyaluronidase human) ROZLYTREK® (entrectinib) SUSVIMO™ (ranibizumab injection) TECENTRIQ® (atezolizumab) TECENTRIQ HYBREZA™ (atezolizumab and hyaluronidase-tqjs) VABYSMO® (faricimab-svoa) VENCLEXTA® (venetoclax tablets) XOLAIR® (omalizumab) for subcutaneous use ZELBORAF® (vemurafenib) Oncology Ophthalmology Rheumatology

MySMA Support for Evrysdi

MySMA Support is a service from Genentech that can help provide information about Evrysdi.

The MySMA Support team can help you understand your patient’s insurance coverage and refer your patients to appropriate financial assistance options to help them start and stay on Evrysdi:

  • Partnership and Access Liaison (PAL): The local, main point of contact from Genentech who supports your patients
    • PALs do not provide medical advice. A PAL will always direct patients to their health care providers for any questions about the patient's health and/or medical care
  • Neurological Rare Disease Account Manager (NRD AM): The local, dedicated support resource for practices who answers questions about Genentech’s approved products and services, including answering:
    • Evrysdi clinical questions
    • General reimbursement and insurance questions
    • Evrysdi Start Form questions
  • Case Manager (CM): Partners closely with you and the PAL to help your patients understand the health insurance process and identify potential financial support options for Genentech's approved products
  • Specialty pharmacy (SP)*: An SP prepares and ships Evrysdi directly to patients each month. Although the SP is not a part of Genentech, it is an important part of the MySMA Support team

*Specialty pharmacies are not part of Genentech and maintain independence in their operations and in their role as a health care provider.

enrollment

Enrollment

  • The Evrysdi Start Form is used to enroll people who have been prescribed Evrysdi into MySMA Support
  • The Start Form includes the Patient Consent Form (page 4), which is to be completed by the patient, and the Prescriber Service Form (page 6), which is to be completed by the health care provider
  • Both pages must be completed for enrollment
product education

Product education

  • Information about the effectiveness and important safety information of Evrysdi
  • Guidance on administering Evrysdi
insurance and financial assistance

Insurance and financial assistance

  • Insurance benefits investigation
  • Resources to help the health care provider's office with prior authorizations and appeals
  • Financial assistance for eligible individuals, including co-pay and free drug programs
additional support

Additional support

  • Coordination with the SP for preparation and delivery of Evrysdi
  • Disease- and treatment-related educational materials

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.

phone

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

form

To enroll in MySMA Support, complete and submit the Evrysdi Start Form